Healthcare Provider Details

I. General information

NPI: 1497449797
Provider Name (Legal Business Name): KAYLA ROACH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY ST STE 404
CONCORD NH
03301-3549
US

IV. Provider business mailing address

184 GOBORO RD B
EPSOM NH
03234
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7827
  • Fax:
Mailing address:
  • Phone: 401-369-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5161
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: