Provider Demographics
NPI:1740351881
Name:ROCHELEAU, KELLY (MPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ROCHELEAU
Suffix:
Gender:
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1101
Mailing Address - Country:US
Mailing Address - Phone:803-329-4685
Mailing Address - Fax:803-329-4683
Practice Address - Street 1:1757 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1101
Practice Address - Country:US
Practice Address - Phone:803-329-4685
Practice Address - Fax:803-329-4683
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT108052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY041JXMedicare PIN