Doctor Name: | MR. RONAN LEVA ROQUE |
NPI Number: | 1063516664 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | PT 11025 |
Business Practice Address: | 189 Covered Bridge Drive Ocoee, FL - 347613351 |
Business Phone Number: | 4079050365 |
Business Fax Number: | 4079050365 |
Mailing Address: | 189 Covered Bridge Drive, OCOEE |
State: | FL |
Postal Code: | 347613351 |
Phone Number: | 4079050365 |
Fax Number: | 4079050365 |
NPI Enumeration Date: | 09/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | PT 11025 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |