Provider Demographics
NPI:1730439308
Name:LA ROACH, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LA ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 PARK MEADOWS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5528
Mailing Address - Country:US
Mailing Address - Phone:303-790-7877
Mailing Address - Fax:
Practice Address - Street 1:10450 PARK MEADOWS DR STE 103
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5528
Practice Address - Country:US
Practice Address - Phone:303-790-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist