Organization
FIRM FOUNDATION PEDIATRIC THER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY A ROACH DPT (OWNER)
(318) 224-9081
Entity
Organization
Contact information
Practice address
1316 E KENTUCKY AVE, RUSTON, LA 71270-6609
(318) 224-9081
Mailing address
683 ROACH RD, CHOUDRANT, LA 71227-3630
(318) 918-0756
Taxonomy
Speciality
Code
Description
License number
State
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1884600
—
LA
Enumeration date
07/30/2021
Last updated
07/26/2023
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