Provider Demographics
NPI:1548730880
Name:REEDER, ROCHELL GERONIMO (PT)
Entity type:Individual
Prefix:MRS
First Name:ROCHELL
Middle Name:GERONIMO
Last Name:REEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ROCHELL
Other - Middle Name:KONG
Other - Last Name:GERONIMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 76 BOX 4098
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-0041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2003 1A
Practice Address - Street 2:
Practice Address - City:YOKOTA AIR FORCE BASE
Practice Address - State:TOKYO
Practice Address - Zip Code:96326
Practice Address - Country:JP
Practice Address - Phone:754-281-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NMPT5395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty