Provider Demographics
NPI:1396261137
Name:OBROCK, CRAIG JAMES (DPT)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JAMES
Last Name:OBROCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 STATE ROUTE 199
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9103
Mailing Address - Country:US
Mailing Address - Phone:419-409-0626
Mailing Address - Fax:
Practice Address - Street 1:4379 E GRAND RIVER AVE STE 12
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6583
Practice Address - Country:US
Practice Address - Phone:517-586-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist