Individual
JESSICA BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
125 DILLMONT DR, COLUMBUS, OH 43235-4658
(614) 844-5433
Mailing address
125 DILLMONT DR, COLUMBUS, OH 43235-4658
(614) 844-5433
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
OH.013453
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OO72761
—
OH
Enumeration date
11/13/2014
Last updated
03/30/2015
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