Individual
MR. BROCK ZACHERY CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
10614 CANYON RD E, PUYALLUP, WA 98373-4257
(253) 535-6006
Mailing address
10614 CANYON RD E, PUYALLUP, WA 98373-4257
(253) 535-6006
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
60745705
WA
Other
Enumeration date
06/19/2017
Last updated
03/17/2018
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