Provider Demographics
NPI:1366742827
Name:ROCK, EILEEN L (LMT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:L
Last Name:ROCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:LYLE
Mailing Address - State:WA
Mailing Address - Zip Code:98635-0012
Mailing Address - Country:US
Mailing Address - Phone:541-490-9958
Mailing Address - Fax:
Practice Address - Street 1:145 E JEWETT BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672
Practice Address - Country:US
Practice Address - Phone:541-490-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00020982172M00000X
OR11917172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist