Provider Demographics
NPI:1023505898
Name:ROACH, MELANIE (DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13765
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0765
Mailing Address - Country:US
Mailing Address - Phone:501-604-5600
Mailing Address - Fax:
Practice Address - Street 1:10301 N RODNEY PARHAM RD STE B1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-4838
Practice Address - Country:US
Practice Address - Phone:501-604-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist