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NPI Code Detail

MEDICARE: DR. LAURA ROACH PT, DPT

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
1225100000XPhysical TherapistPTL.0020096CO

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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Directions to “ DR. LAURA ROACH PT, DPT” Practice Location

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