Provider Demographics
NPI:1700307311
Name:BOCHE, JERONIMO ALBERTO (ATC)
Entity Type:Individual
Prefix:
First Name:JERONIMO
Middle Name:ALBERTO
Last Name:BOCHE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES MADISON UNIVERSITY
Mailing Address - Street 2:261 BLUESTONE DR/ MSC 2301
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807
Mailing Address - Country:US
Mailing Address - Phone:540-568-8020
Mailing Address - Fax:540-568-5351
Practice Address - Street 1:220 CHAMPIONS DR.
Practice Address - Street 2:APC ATHLETIC TRAINING ROOM
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807
Practice Address - Country:US
Practice Address - Phone:540-568-8020
Practice Address - Fax:540-568-5351
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260027712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer