Provider Demographics
NPI:1770685406
Name:ROCHE, NICOLE (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12908 TURKEY BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3341
Mailing Address - Country:US
Mailing Address - Phone:301-933-2099
Mailing Address - Fax:
Practice Address - Street 1:14527 PICKET OAKS RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2358
Practice Address - Country:US
Practice Address - Phone:703-222-2421
Practice Address - Fax:703-222-2421
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050062822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics