Individual
JENNIFER LEE MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS PT
Contact information
Practice address
11030 RAVEN RIDGE RD, SUITE 101, RALEIGH, NC 27614-8511
(919) 844-6611
(919) 844-6612
Mailing address
11030 RAVEN RIDGE RD, SUITE 101, RALEIGH, NC 27614-8511
(919) 844-6611
(919) 844-6612
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9860
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079KY
BCBS
—
01
—
6400040
UNITED HEALTHCARE
—
05
—
7211654
—
NC
01
—
7821632
AETNA
—
05
—
8300041K
—
NC
01
—
D9461
MEDCOST
—
Enumeration date
12/22/2006
Last updated
08/10/2008
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