Individual
KAYLA DANIELLE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
166 OAKLAND PKWY, LEESBURG, GA 31763-7200
(229) 495-6079
Mailing address
166 OAKLAND PKWY, LEESBURG, GA 31763-7200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003390
GA
Other
Enumeration date
04/12/2019
Last updated
04/12/2019
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