Provider Demographics
NPI:1699982835
Name:BROCK, TERESSA MARY (PT)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:MARY
Last Name:BROCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:MARY
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1720 SUNDOWN DR
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-8134
Mailing Address - Country:US
Mailing Address - Phone:701-720-6354
Mailing Address - Fax:
Practice Address - Street 1:2311 ELK DR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5633
Practice Address - Country:US
Practice Address - Phone:701-720-6354
Practice Address - Fax:701-839-4076
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist