# MR. SEAN MICHAEL ROACH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1952381006
- **Gender:** Man
- **Credential:** PHD, PT, DPT, ATC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 04555 | OR | — |
| 225100000X | Physical Therapist | — | NULL | Yes |

## Other

- **Enumeration date:** 01/17/2006
- **Last updated:** 06/07/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8632629771 | STATE OF OREGON | OR |