Provider Demographics
NPI:1366419228
Name:BOCK, DAVID CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:BOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SAINT MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2513
Mailing Address - Country:US
Mailing Address - Phone:504-347-9255
Mailing Address - Fax:
Practice Address - Street 1:NAVAL SUPPORT ACTIVITY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70142-0001
Practice Address - Country:US
Practice Address - Phone:504-678-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist