Individual
ETHAN MCCOY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
214 LANEFIELD RD, WARSAW, NC 28398-8719
(910) 293-3144
Mailing address
113 MAYSVILLE SCHOOL RD, MOUNT OLIVE, NC 28365-6541
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6671
NC
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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