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Individual

MR. PETER BROCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSED, ATC, LAT

Contact information

Practice address
1201 WESLEYAN STREET, FORT WORTH, TX 76105-1215
(817) 531-7590
Mailing address
1201 WESLEYAN ST, FT WORTH, TX 76105-1536
(817) 531-7590

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT4498
TX

Other

Enumeration date
08/21/2009
Last updated
08/22/2016
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