Provider Demographics
NPI:1689364515
Name:ROACH, DAKOTAH ALAN (PTA)
Entity Type:Individual
Prefix:
First Name:DAKOTAH
Middle Name:ALAN
Last Name:ROACH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18915 E APPLEWAY AVE STE A101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8856
Mailing Address - Country:US
Mailing Address - Phone:509-928-3443
Mailing Address - Fax:
Practice Address - Street 1:18915 E APPLEWAY AVE STE A101
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8856
Practice Address - Country:US
Practice Address - Phone:509-928-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61335779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant