Individual
HOLLY A ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
414 SO. 54TH ST., TACOMA, WA 98408
(253) 548-6738
Mailing address
414 SO. 54TH ST., TACOMA, WA 98408
(253) 548-6738
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60112051
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60112051
LMP
WA
Enumeration date
11/11/2009
Last updated
11/11/2009
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