Basic Information
Provider Information | |||||||||
NPI: | 1780857482 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VESPIE | ||||||||
FirstName: | ROCHELLE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PTA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARRETTE | ||||||||
OtherFirstName: | ROCHELLE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PTA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 17900 23 MILE RD | ||||||||
Address2: | SUITE 401 | ||||||||
City: | MACOMB | ||||||||
State: | MI | ||||||||
PostalCode: | 480441161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5868689040 | ||||||||
FaxNumber: | 5868689013 | ||||||||
Practice Location | |||||||||
Address1: | 17900 23 MILE RD | ||||||||
Address2: | SUITE 401 | ||||||||
City: | MACOMB | ||||||||
State: | MI | ||||||||
PostalCode: | 480441161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5868689040 | ||||||||
FaxNumber: | 5868689013 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/02/2008 | ||||||||
LastUpdateDate: | 10/14/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06003028A | IN | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |   |
No ID Information.