Active NPI
Ronan Leva Roque, P.T.
- Geriatric Physical Therapist
- Ocoee, FL
National Provider Identifier
1063516664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT 11025
- Practice address
- 189 Covered Bridge Drive
Ocoee, FL 34761-3351 - Phone
- (407) 905-0365
- Fax
- (407) 905-0365
- NPI assigned
- Sep 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT 11025 | FL | Primary |
Addresses
Primary practice location
189 Covered Bridge Drive
Ocoee, FL 34761-3351
Mailing address
189 Covered Bridge Drive
Ocoee, FL 34761-3351
Phone (407) 905-0365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 11025 | FL | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063516664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "189 COVERED BRIDGE DRIVE",
"city": "OCOEE",
"state": "FL",
"postal_code": "347613351",
"telephone_number": "407-905-0365",
"fax_number": "407-905-0365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "189 COVERED BRIDGE DRIVE",
"city": "OCOEE",
"state": "FL",
"postal_code": "347613351",
"telephone_number": "407-905-0365",
"fax_number": "407-905-0365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "RONAN",
"middle_name": "LEVA",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "FL",
"license": "PT 11025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ocoee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.