| Doctor Name: | RICHARD EARL DE ROQUE |
| NPI Number: | 1982835542 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT1308 |
| Business Practice Address: | 74 Cleburne Park Rd Heber Springs, AR - 725439106 |
| Business Phone Number: | 5012060920 |
| Business Fax Number: | |
| Mailing Address: | 1840 Columbia Dr, CONWAY |
| State: | AR |
| Postal Code: | 720347392 |
| Phone Number: | 5014721271 |
| Fax Number: | 5015139143 |
| NPI Enumeration Date: | 07/30/2009 |
| NPI Last Update Date: | 02/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT1308 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |