| NPI | 1518948546 |
|---|---|
| Former Name | MAXINE GERTRUDE BROCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 4000) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NC 1021100288) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2014-06-16 |