Healthcare Provider Details

I. General information

NPI: 1356384853
Provider Name (Legal Business Name): PAULA ROCHA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROUTE 63
WAYLAND NY
14572-9509
US

IV. Provider business mailing address

2350 ROUTE 63
WAYLAND NY
14572-9509
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-3541
  • Fax: 585-728-5658
Mailing address:
  • Phone: 585-728-3541
  • Fax: 585-728-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberRI01252
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: