MEDICARE: ALEX ROQUE PT

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	310143	CA

General Provider Information

NPI Number	:	1114855756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX ROQUE PT

Provider Business Mailing Address
First Line	:	10343 CRAB APPLE DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-8847
Country	:	US
Telephone Number	:	209-373-0994
Fax Number	:

Provider Business Practice Location Address
First Line	:	10343 CRAB APPLE DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-8847
Country	:	US
Telephone Number	:	209-373-0994
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ ALEX ROQUE PT” Practice Location

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