Provider Demographics
NPI:1720568488
Name:BREEMES, ROCHELLE B
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:B
Last Name:BREEMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CHAPEL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8114
Mailing Address - Country:US
Mailing Address - Phone:254-717-4731
Mailing Address - Fax:
Practice Address - Street 1:300 W STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4041
Practice Address - Country:US
Practice Address - Phone:254-717-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2122071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant