Individual
RICHARD EARL DE ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
74 CLEBURNE PARK RD, HEBER SPRINGS, AR 72543-9106
(501) 206-0920
Mailing address
1840 COLUMBIA DR, CONWAY, AR 72034-7392
(501) 472-1271
(501) 513-9143
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1308
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125613721
—
AR
Enumeration date
07/30/2009
Last updated
02/06/2010
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