Provider Demographics
NPI:1962817841
Name:BROCK, JEREMY (RRT, RCP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BROCK
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRT
Mailing Address - Street 1:105 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6563
Mailing Address - Country:US
Mailing Address - Phone:478-955-9370
Mailing Address - Fax:
Practice Address - Street 1:8415 DATAPOINT DR.
Practice Address - Street 2:PARALLON WORKFORCE MANAGEMENT SOLUTIONS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-593-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76227227900000X, 2279E0002X, 2279E1000X, 2279G1100X, 2279P1004X
TX766272279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
No2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care
No2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics