Provider Demographics
NPI:1215917398
Name:ROACH, RACHEL W (MPT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:W
Last Name:ROACH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 NE SAGE LN
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9613
Mailing Address - Country:US
Mailing Address - Phone:541-852-3271
Mailing Address - Fax:541-345-3559
Practice Address - Street 1:494 SW VETERANS WAY STE 1
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6408
Practice Address - Country:US
Practice Address - Phone:541-852-3271
Practice Address - Fax:541-345-3559
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215917398OtherNPI