Active NPI
Victor Manuel Roque, PTA
- Physical Therapy Assistant
- Sanford, FL
National Provider Identifier
1962750778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 23530
- Practice address
- 1200 Lexington Green Lane
Sanford, FL 32771 - Phone
- (407) 688-0070
- NPI assigned
- Aug 28, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 23530 | FL | Primary |
Addresses
Primary practice location
1200 Lexington Green Lane
Sanford, FL 32771
Mailing address
664 Crooked Creek Drive
Ocoee, FL 34761
Phone (407) 970-6097
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 |
|---|---|---|---|
| 23530 | FL | MD | Occupational Therapist |
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1962750778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "664 CROOKED CREEK DRIVE",
"city": "OCOEE",
"state": "FL",
"postal_code": "34761",
"telephone_number": "407-970-6097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 LEXINGTON GREEN LANE",
"city": "SANFORD",
"state": "FL",
"postal_code": "32771",
"telephone_number": "407-688-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "VICTOR",
"middle_name": "MANUEL",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-28",
"last_updated": "2012-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "23530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.