Provider Demographics
NPI:1316768450
Name:MATHEWS, ROCHELLE L (DD)
Entity type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:L
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:DD
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:L
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8645 PLANTATION RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-1543
Mailing Address - Country:US
Mailing Address - Phone:869-500-0234
Mailing Address - Fax:
Practice Address - Street 1:115 ALLAMANDA DR FL 33803
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2925
Practice Address - Country:US
Practice Address - Phone:863-825-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty