Provider Demographics
NPI:1497158539
Name:ROACH, ANDREA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ROACH
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6002
Mailing Address - Country:US
Mailing Address - Phone:303-914-2680
Mailing Address - Fax:
Practice Address - Street 1:1020 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6002
Practice Address - Country:US
Practice Address - Phone:303-914-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
COPTL.0013670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA381735VKFMedicare PIN