Provider Demographics
NPI:1083781223
Name:ROCHE, JAMES K (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:ROCHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3902
Mailing Address - Country:US
Mailing Address - Phone:724-463-7478
Mailing Address - Fax:724-463-0931
Practice Address - Street 1:805 S ATHERTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4671
Practice Address - Country:US
Practice Address - Phone:814-278-1912
Practice Address - Fax:814-278-1921
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005702L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1587551OtherHIGHMARK BLUE SHIELD
PA451169OtherHEALTH AMER.HEALTH ASSUR.
PA50061256OtherCAPITAL-KHPC
PA396749Medicare ID - Type UnspecifiedMEDICARE