Provider Demographics
NPI:1104967603
Name:MEAD, ROCHELLE M (P T)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:M
Last Name:MEAD
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 NW PRIMA VISTA BLVD.,
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-8980
Mailing Address - Fax:772-873-8981
Practice Address - Street 1:405 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-460-2520
Practice Address - Fax:772-460-2521
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917ZOtherBCBS GROUP
FLY056EZMedicare ID - Type UnspecifiedINDIVIDUAL
FLY917ZOtherBCBS GROUP