MEDICARE: MARK DARROCH

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	225200000X	Physical Therapy Assistant	P1 60045618	WA

General Provider Information

NPI Number	:	1467759969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DARROCH

Provider Business Mailing Address
First Line	:	23821 E SINTO AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11315 CORPORATE BLVD STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8340
Country	:	US
Telephone Number	:	800-774-7785
Fax Number	:	877-217-9271

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

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/17/2011

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Directions to “ MARK DARROCH ” Practice Location

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