Provider Demographics
NPI:1972741015
Name:EDMONDS, BROCK ANDREW (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:BROCK
Middle Name:ANDREW
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SW GAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1831
Mailing Address - Country:US
Mailing Address - Phone:785-273-1379
Mailing Address - Fax:
Practice Address - Street 1:4015 SW GAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1831
Practice Address - Country:US
Practice Address - Phone:785-273-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24006452255A2300X
TXAT40522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer