Provider Demographics
NPI:1154934339
Name:LAROCHE, VALERY EE (MMP)
Entity type:Individual
Prefix:MR
First Name:VALERY
Middle Name:EE
Last Name:LAROCHE
Suffix:
Gender:M
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 ROSWELL RD APT 333
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7519
Mailing Address - Country:US
Mailing Address - Phone:770-330-5052
Mailing Address - Fax:
Practice Address - Street 1:5944 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4908
Practice Address - Country:US
Practice Address - Phone:404-236-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist