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General NPI Number Information
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NPI Number | 1275678336
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Entity Type | Organization
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Legal Business Name | CYNTHIA J. ROCHE, RPT
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 618 FERNCREST DR
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1863
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Country | US
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Telephone | 478-552-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 618 FERNCREST DR P.O. BOX 5880
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1863
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Country | US
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Telephone | 478-552-7878
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CYNTHIA J. ROCHE
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Credential | RPT
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Telephone | 478-552-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1635
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License Number State | GA
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