Doctor Name: | MISS JILL MARIE ROACH |
NPI Number: | 1437433349 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 17143 |
Business Practice Address: | 84 Willimansett St South Hadley, MA - 010753062 |
Business Phone Number: | 4135538501 |
Business Fax Number: | 4135338502 |
Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
State: | IL |
Postal Code: | 604404909 |
Phone Number: | 6302962223 |
Fax Number: | |
NPI Enumeration Date: | 10/11/2011 |
NPI Last Update Date: | 04/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 17143 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |