Healthcare Provider Details

I. General information

NPI: 1093836595
Provider Name (Legal Business Name): GRETA P. ROOF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

IV. Provider business mailing address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-4517
  • Fax: 270-852-1491
Mailing address:
  • Phone: 706-834-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number8208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: