Dereni Blake Brock, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

006310 Issued in KY

Practice address

195 Commercial Dr
Ste 100
London, KY 40744-5234

Phone

(606) 657-2354

Fax

(606) 657-2354

NPI assigned

Dec 6, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Kentucky College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revolution Physical TherapyGroup PAC ID 6507106812, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revolution Physical Therapy

  • Physical Therapy Clinic/Center
  • London, KY
  • NPI 1992277107

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Revolution Physical Therapy Corbin

  • Physical Therapist
  • Corbin, KY
  • NPI 1861231524
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1114358702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 COMMERCIAL DR",
            "address_2": "STE 100",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407445234",
            "telephone_number": "606-657-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 COMMERCIAL DR",
            "address_2": "STE 100",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407445234",
            "telephone_number": "606-657-2354",
            "fax_number": "606-657-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "DERENI",
        "middle_name": "BLAKE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-06",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgeway Health PLLC
• Marc Briere, MD
• Brightview LLC
• Brenda Brison, MED, TCM, TCADC
• Brock Medical, LLC
• Jessica Marie Brock, APRN
• Nadine Brock, APRN
• Olivia Anne Brock, CRNA
• Stephanie Ann Brock, LCADC
• Kevin Brooks, PA

• Physical Therapist in London, KY
• Providers in London, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.