Provider Demographics
NPI:1730502220
Name:LAROCHELLE, PEGGY STOTTLEMYER (PT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:STOTTLEMYER
Last Name:LAROCHELLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SMITH SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1405
Mailing Address - Country:US
Mailing Address - Phone:423-605-9396
Mailing Address - Fax:
Practice Address - Street 1:100 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1860
Practice Address - Country:US
Practice Address - Phone:423-886-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist