Provider Demographics
NPI:1093427601
Name:ROCHE, EAN MICHAEL
Entity Type:Individual
Prefix:
First Name:EAN
Middle Name:MICHAEL
Last Name:ROCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 33RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6795
Mailing Address - Country:US
Mailing Address - Phone:410-366-0791
Mailing Address - Fax:
Practice Address - Street 1:1100 E 33RD ST STE 105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6795
Practice Address - Country:US
Practice Address - Phone:443-819-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant