Provider Demographics
NPI:1821334202
Name:ROQUE, SHERWIN CABRERA (PT)
Entity Type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:CABRERA
Last Name:ROQUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3042
Mailing Address - Country:US
Mailing Address - Phone:413-455-2300
Mailing Address - Fax:413-455-2330
Practice Address - Street 1:169 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3042
Practice Address - Country:US
Practice Address - Phone:413-455-2300
Practice Address - Fax:413-455-2330
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA009299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist