MEDICARE: KELLY ROCHELEAU MPT

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	2251X0800X	Orthopedic Physical Therapist	PT10805	SC

General Provider Information

NPI Number	:	1740351881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ROCHELEAU MPT

Provider Business Mailing Address
First Line	:	1757 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1101
Country	:	US
Telephone Number	:	803-329-4685
Fax Number	:	803-329-4683

Provider Business Practice Location Address
First Line	:	1757 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1101
Country	:	US
Telephone Number	:	803-329-4685
Fax Number	:	803-329-4683

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	03/03/2025

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Directions to “ KELLY ROCHELEAU MPT” Practice Location

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