Healthcare Provider Details

I. General information

NPI: 1295103372
Provider Name (Legal Business Name): MRS. ROXANNE RICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WATER ST
ST AUGUSTINE FL
32084-2887
US

IV. Provider business mailing address

927 GRACE AVE
PANAMA CITY FL
32401-2521
US

V. Phone/Fax

Practice location:
  • Phone: 727-364-4024
  • Fax:
Mailing address:
  • Phone: 850-769-5371
  • Fax: 850-872-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTA24885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: