Provider Demographics
NPI:1548552557
Name:ROCK, MARY (ATC, LAT, SA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:ATC, LAT, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10796 VALENCIA HILLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 PARK CENTRAL DR STE 401
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-6935
Practice Address - Country:US
Practice Address - Phone:720-916-3802
Practice Address - Fax:303-662-9056
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer