Provider Demographics
NPI:1124206172
Name:ROARK, CRISTY LYNN (DI)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:LYNN
Last Name:ROARK
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 PINE TOP RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9247
Mailing Address - Country:US
Mailing Address - Phone:606-813-0265
Mailing Address - Fax:606-877-9712
Practice Address - Street 1:3086 PINE TOP RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9247
Practice Address - Country:US
Practice Address - Phone:606-813-0265
Practice Address - Fax:606-877-9712
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist