Provider Demographics
NPI:1336708155
Name:ROCK, TAYLOR SUE (PT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SUE
Last Name:ROCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 W GOODYEAR BLVD N APT 212
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1544
Mailing Address - Country:US
Mailing Address - Phone:435-770-8158
Mailing Address - Fax:
Practice Address - Street 1:17200 W PEORIA AVE
Practice Address - Street 2:STE 122
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388
Practice Address - Country:US
Practice Address - Phone:623-274-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist