MEDICARE: DR. LAURA ROACH PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0020096	CO

General Provider Information

NPI Number	:	1902639040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA ROACH PT, DPT

Provider Business Mailing Address
First Line	:	110 BROADMOOR HILLS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4383
Country	:	US
Telephone Number	:	719-332-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BROADMOOR HILLS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4383
Country	:	US
Telephone Number	:	719-332-9761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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