Active NPI
Robert Thomas Roche III, A.T.C.
- Athletic Trainer
- Eden Prairie, MN
National Provider Identifier
1366464182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1939
- Practice address
- 9520 Viking Dr
Eden Prairie, MN 55344-3825 - Phone
- (612) 741-5645
- Fax
- (952) 828-6555
- NPI assigned
- Jul 24, 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1939 | MN | Primary |
Addresses
Primary practice location
9520 Viking Dr
Eden Prairie, MN 55344-3825
Mailing address
378 Brickyard Dr
Chaska, MN 55318-2403
Phone (612) 741-5645
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1939 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366464182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "378 BRICKYARD DR",
"city": "CHASKA",
"state": "MN",
"postal_code": "553182403",
"telephone_number": "612-741-5645",
"fax_number": "952-828-6555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9520 VIKING DR",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443825",
"telephone_number": "612-741-5645",
"fax_number": "952-828-6555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROCHE",
"first_name": "ROBERT",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "A.T.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
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.