Provider Demographics
NPI:1891161923
Name:ROCHE, STEPHANIE MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:ROCHE
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:BLDG. 4200-WILSON HALL
Mailing Address - Street 2:HARMONY CHURCH
Mailing Address - City:FT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:762-850-9336
Mailing Address - Fax:762-850-9336
Practice Address - Street 1:BLDG. 4200-WILSON HALL
Practice Address - Street 2:HARMONY CHURCH
Practice Address - City:FT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-366-7415
Practice Address - Fax:706-366-7415
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012033225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist