Individual
CHARLES ROQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
5211 E WASHINGTON BLVD, STE 18, COMMERCE, CA 90040-3959
(323) 980-9825
(323) 980-9898
Mailing address
5211 E WASHINGTON BLVD, STE 18, COMMERCE, CA 90040-3959
(323) 980-9825
(323) 980-9898
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT24193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT24193
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
03/24/2010
Last updated
11/29/2021
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