| Doctor Name: | MRS. DERENI BLAKE BROCK |
| NPI Number: | 1114358702 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 006310 |
| Business Practice Address: | 1690 Highway 192 W London, KY - 407411673 |
| Business Phone Number: | 6068773231 |
| Business Fax Number: | 6068773632 |
| Mailing Address: | 383 Corbin Center Dr, CORBIN |
| State: | KY |
| Postal Code: | 407011895 |
| Phone Number: | 6065262909 |
| Fax Number: | 6065262901 |
| NPI Enumeration Date: | 12/06/2013 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 006310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |