Provider Demographics
NPI:1902870629
Name:LAROCHE, SUSAN MARIE (PT/ LATC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:LAROCHE
Suffix:
Gender:F
Credentials:PT/ LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GOWING RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-5124
Mailing Address - Country:US
Mailing Address - Phone:603-595-7125
Mailing Address - Fax:603-880-8465
Practice Address - Street 1:88 GOWING RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-5124
Practice Address - Country:US
Practice Address - Phone:603-595-7125
Practice Address - Fax:603-880-8465
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5632225100000X
NH02512255A2300X
MA3052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer