| Doctor Name: | LAURA L ROACH |
| NPI Number: | 1164591020 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | |
| Business Practice Address: | 3308 Logan Dr Herrin, IL - 629483759 |
| Business Phone Number: | 6189934024 |
| Business Fax Number: | 6189931570 |
| Mailing Address: | Po Box 50, JOHNSTON CITY |
| State: | IL |
| Postal Code: | 629510050 |
| Phone Number: | 6189835912 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 10/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |