Provider Demographics
NPI:1346815172
Name:BROCK, BREANNA MARIE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:BROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CHESTER STREET, LAKENHEATH
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:IP27 9PS
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36TH MEDICAL GROUP
Practice Address - Street 2:UNIT 14010 BLDG. 26012
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96543
Practice Address - Country:UM
Practice Address - Phone:671-366-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist