Provider Demographics
NPI:1275678336
Name:CYNTHIA J. ROCHE, RPT
Entity Type:Organization
Organization Name:CYNTHIA J. ROCHE, RPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:478-552-7878
Mailing Address - Street 1:618 FERNCREST DR
Mailing Address - Street 2:P.O. BOX 5880
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1863
Mailing Address - Country:US
Mailing Address - Phone:478-552-7878
Mailing Address - Fax:
Practice Address - Street 1:618 FERNCREST DR
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1863
Practice Address - Country:US
Practice Address - Phone:478-552-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000766303BMedicaid
GA000746303AMedicaid
GA000746303AMedicaid