Healthcare Provider Details

I. General information

NPI: 1447659180
Provider Name (Legal Business Name): KRISTEN STEPHANIE ROARK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28632 DUPONT BLVD
MILLSBORO DE
19966-4793
US

IV. Provider business mailing address

26193 RICH FIELD DR
LEWES DE
19958-6881
US

V. Phone/Fax

Practice location:
  • Phone: 302-934-0304
  • Fax:
Mailing address:
  • Phone: 862-266-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number2461
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003208
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: