Provider Demographics
NPI:1356010219
Name:ROARK, HANNAH ELAINE (DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELAINE
Last Name:ROARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 EDGEWATER LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6944
Mailing Address - Country:US
Mailing Address - Phone:864-556-3194
Mailing Address - Fax:803-957-3372
Practice Address - Street 1:5432A AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3892
Practice Address - Country:US
Practice Address - Phone:803-957-3373
Practice Address - Fax:803-957-3372
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10880261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy