Provider Demographics
NPI:1093427601
Name:ROCHE, EAN MICHAEL
Entity type:Individual
Prefix:
First Name:EAN
Middle Name:MICHAEL
Last Name:ROCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 20TH ST NW STE 116
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3406
Mailing Address - Country:US
Mailing Address - Phone:240-825-2561
Mailing Address - Fax:
Practice Address - Street 1:1120 20TH ST NW STE 116
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3406
Practice Address - Country:US
Practice Address - Phone:240-825-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5771225200000X
DCPTA2000040DC225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant