Basic Information
| Provider Information | |||||||||
| NPI: | 1770759318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOCK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2205 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756523515 | ||||||||
| FaxNumber: | 5756523518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756523515 | ||||||||
| FaxNumber: | 5756523518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2008 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06002855A | IN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 6415A | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2054760 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2271 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225100000X | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.