Individual
AMY J ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PARKER ST, BOSCOBEL, WI 53805-1642
(608) 375-4112
Mailing address
205 PARKER ST, BOSCOBEL, WI 53805-1642
(608) 375-4112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40323800
—
WI
Enumeration date
10/16/2008
Last updated
10/16/2008
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