Healthcare Provider Details

I. General information

NPI: 1134746068
Provider Name (Legal Business Name): NATALIE ROE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

IV. Provider business mailing address

68 FREEDOM LAKE SOUTH CT
VALPARAISO IN
46385-7387
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2739
  • Fax:
Mailing address:
  • Phone: 219-508-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12839
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: