Organization
BROCK LISTER PT PA
Active
Organization
BROCK LISTER PT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK LISTER (OWNER)
(716) 523-1783
Entity
Organization
Contact information
Practice address
2534 WOOD POINTE DR, HOLIDAY, FL 34691-7803
(716) 523-1783
Mailing address
2534 WOOD POINTE DR, HOLIDAY, FL 34691-7803
(716) 523-1783
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
31894
FL
Other
Enumeration date
05/07/2017
Last updated
05/07/2017
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