MEDICARE: STEPHANIE MICHELLE ROCHE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012033	GA
2	2251X0800X	Orthopedic Physical Therapist	012033	GA

General Provider Information

NPI Number	:	1891161923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MICHELLE ROCHE P.T.

Provider Business Mailing Address
First Line	:	BLDG. 4200-WILSON HALL
Second Line	:	HARMONY CHURCH
City	:	FT MOORE
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	762-850-9336
Fax Number	:	762-850-9336

Provider Business Practice Location Address
First Line	:	BLDG. 4200-WILSON HALL
Second Line	:	HARMONY CHURCH
City	:	FT MOORE
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	706-366-7415
Fax Number	:	706-366-7415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	12/05/2023

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