Individual
CARLY PAIGE ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
(318) 813-2970
(318) 813-2981
Mailing address
29185 HIGHWAY 191, MANY, LA 71449-6313
(318) 590-9140
(318) 590-9141
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10261
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174173
—
LA
Enumeration date
07/25/2019
Last updated
02/10/2022
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