Provider Demographics
NPI:1285163105
Name:ROA, MICHELLE K (ATC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:ROA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-610-0421
Mailing Address - Fax:
Practice Address - Street 1:1000 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ARTHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-4301
Practice Address - Country:US
Practice Address - Phone:650-543-3753
Practice Address - Fax:650-543-4497
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer