Provider Demographics
NPI:1366402729
Name:ROCHA, JOHN JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:ROCHA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4704
Mailing Address - Country:US
Mailing Address - Phone:201-615-0594
Mailing Address - Fax:
Practice Address - Street 1:2164 HIGHWAY 35 BLDG C
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-1313
Practice Address - Fax:732-974-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027755225100000X
NJ40QA01197100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
106346PCSMedicare ID - Type Unspecified