Individual
KRISTIE LYN BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1750 MCGILCHRIST ST SE STE 130, SALEM, OR 97302-1691
(971) 304-2200
Mailing address
1750 MCGILCHRIST ST SE STE 130, SALEM, OR 97302-1691
(971) 304-2200
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5502001181
MI
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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