Provider Demographics
NPI:1528535630
Name:LAROUCHE, STEVEN (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:LAROUCHE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 MURPHY CT
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9053
Mailing Address - Country:US
Mailing Address - Phone:810-247-4527
Mailing Address - Fax:
Practice Address - Street 1:731 STARKWEATHER DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1128
Practice Address - Country:US
Practice Address - Phone:517-323-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant