Individual
SUSAN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
3260 VINEVILLE AVE, MACON, GA 31204-2324
(478) 960-6366
Mailing address
3260 VINEVILLE AVE, MACON, GA 31204-2324
(478) 960-6366
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT001483
GA
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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