Provider Demographics
NPI:1992683460
Name:ROACH BLAKE, PATRICIA JEANNE D'ARC (LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANNE D'ARC
Last Name:ROACH BLAKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HONEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1708
Mailing Address - Country:US
Mailing Address - Phone:860-849-9446
Mailing Address - Fax:
Practice Address - Street 1:744 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2307
Practice Address - Country:US
Practice Address - Phone:860-365-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist