Provider Demographics
NPI:1376072868
Name:ROACH, HEIDI (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:BRIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:11217 N RADNER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5531
Mailing Address - Country:US
Mailing Address - Phone:860-625-7492
Mailing Address - Fax:
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-684-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer