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General NPI Number Information
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NPI Number | 1245624824
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Entity Type | Individual
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Provider Name | CLARICE ROACH-SMITH PT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 10592 CHAMPAGNE RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-6930
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Country | US
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Telephone | 909-463-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 23952 BRITTLEBUSH CIR
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City | MORENO VALLEY
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State | CA
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Zip | 92557-2933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18872
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License Number State | CA
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