Individual
MARCUS ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
912 OAKCREST DR. APT D, CHARLESTON, IL 61920
(217) 208-1415
Mailing address
912 OAKCREST DR APT D, CHARLESTON, IL 61920-1780
(785) 338-1964
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007167
IL
Other
Enumeration date
08/30/2017
Last updated
08/30/2017
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