Provider Demographics
NPI:1134286776
Name:PETERSON, ROCHELLE LEIGH (MSPT)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LEIGH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 EAST PARK WOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5819
Mailing Address - Country:US
Mailing Address - Phone:407-970-5582
Mailing Address - Fax:
Practice Address - Street 1:1211 STATE ROAD 436
Practice Address - Street 2:SUITE 1211
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-7223
Practice Address - Country:US
Practice Address - Phone:407-619-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist