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Individual

MRS. DEANN LYNN ROACH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S. P.T.

Contact information

Practice address
111 LAGRUE, SHERWOOD, AR 72120
(501) 779-1286
Mailing address
111 LAGRUE, SHERWOOD, AR 72120
(501) 779-1286

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1467
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5T318
BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/03/2007
Last updated
07/09/2007
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