| NPI | 1063629178 |
|---|---|
| Former Name | CARLENE MARY ROACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 4071) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-06-25 |