Provider Demographics
NPI:1972288520
Name:ROCHESTER, EVIONN
Entity Type:Individual
Prefix:
First Name:EVIONN
Middle Name:
Last Name:ROCHESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11169 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2935
Mailing Address - Country:US
Mailing Address - Phone:407-347-8936
Mailing Address - Fax:352-404-6909
Practice Address - Street 1:11169 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2935
Practice Address - Country:US
Practice Address - Phone:407-347-8936
Practice Address - Fax:352-404-6909
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist