Provider Demographics
NPI:1538368279
Name:LA ROCHELLE, MARGARET SMITH (RPT)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:SMITH
Last Name:LA ROCHELLE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:SMITH
Other - Last Name:LAROCHELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:1261 TRAVIS BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4897
Mailing Address - Country:US
Mailing Address - Phone:707-427-5029
Mailing Address - Fax:707-427-5023
Practice Address - Street 1:1261 TRAVIS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4897
Practice Address - Country:US
Practice Address - Phone:707-427-5029
Practice Address - Fax:707-427-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN8763791OtherDRIVER LICENSE
CAPT 8766OtherPHYSICAL THERAPY