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General NPI Number Information
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NPI Number | 1093427601
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Entity Type | Individual
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Provider Name | EAN MICHAEL ROCHE
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Gender | Male
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1120 20TH ST NW STE 116
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City | WASHINGTON
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State | DC
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Zip | 20036-3406
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Country | US
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Telephone | 240-825-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 20TH ST NW STE 116
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City | WASHINGTON
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State | DC
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Zip | 20036-3406
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Country | US
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Telephone | 240-825-2561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A5771
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA2000040DC
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License Number State | DC
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