Provider Demographics
NPI:1366464182
Name:ROCHE, ROBERT THOMAS III (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:ROCHE
Suffix:III
Gender:M
Credentials:ATC
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Mailing Address - Street 1:378 BRICKYARD DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2403
Mailing Address - Country:US
Mailing Address - Phone:612-741-5645
Mailing Address - Fax:952-828-6555
Practice Address - Street 1:9520 VIKING DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3825
Practice Address - Country:US
Practice Address - Phone:612-741-5645
Practice Address - Fax:952-828-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN19392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer