MRS. DERENI BLAKE BROCK (PT) – Physical Therapist, NPI 1114358702

MRS. DERENI BLAKE BROCK (PT) is a healthcare provider. based in London, Kentucky. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. 006310 (KY). The NPI Number for MRS. DERENI BLAKE BROCK (PT) is 1114358702

Main info

Female
Sole Proprietor
13 Years Of Experience
Accepts Medicare Assignment
Name
MRS. DERENI BLAKE BROCK (PT)
NPI
1114358702
Phone
(606) 657-2354
Address
195 COMMERCIAL DR
Enumeration Date
6 December 2013
Last Update Date
28 October 2019

Doctor Profile

Medical School Name
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Secondary Phone
6065247818
Graduation Year
2013 (13 years ago)
PAC ID
7911230040
Group Practice PAC ID
6507106812
Professional Enrollment ID
I20190605000851
Address ID
KY407445234LO195XXDRXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness75
Years active:12State licenses:1Digital endpointsOther names

1,255 PHYSICAL THERAPIST IN PRIVATE PRACTICE in KY

Provider Addresses for MRS. DERENI BLAKE BROCK (PT)

  • 195 COMMERCIAL DR

    STE 100

    LONDON, KY 407445234

    Phone: (606) 657-2354

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-06-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20190605000851IPhysical Therapist In Private PracticeKYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes68658$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes28544$0
97140Therapy procedure using manual technique, each 15 minutes7725$0
97164Re-evaluation for physical therapy, typically 20 minutes4222$0
97162Evaluation for physical therapy, typically 30 minutes3331$0
View full utilization report →

Insurance plans in this area (ZIP 40744)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6507106812View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeKY
Physical Therapist In Private PracticeKY
Physical Therapist In Private PracticeKY

Reviews

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Frequently asked questions

Does MRS. DERENI BLAKE BROCK (PT) have a public NPI I can cite?
Public records show MRS. DERENI BLAKE BROCK (PT) under NPI 1114358702.
Should I treat MRS. DERENI BLAKE BROCK (PT) as an active provider?
Patients and plans typically see MRS. DERENI BLAKE BROCK (PT) as active in the national extract.
Which specialty label fits MRS. DERENI BLAKE BROCK (PT)?
NPPES ties MRS. DERENI BLAKE BROCK (PT) to Physical Therapist in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is MRS. DERENI BLAKE BROCK (PT) tied to London, Kentucky?
If you are local to London, Kentucky, MRS. DERENI BLAKE BROCK (PT) may be relevant to your search.
Why is information missing for MRS. DERENI BLAKE BROCK (PT)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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