Healthcare Provider Details

I. General information

NPI: 1528522737
Provider Name (Legal Business Name): COURTNEY MARIE ROACH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 109TH AVE NE
BELLEVUE WA
98004-4485
US

IV. Provider business mailing address

2134 WESTERN AVE UNIT 515
SEATTLE WA
98121-4086
US

V. Phone/Fax

Practice location:
  • Phone: 425-233-8766
  • Fax:
Mailing address:
  • Phone: 765-624-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT60863092
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT60863092
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT60863092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: