Provider Demographics
NPI:1821752296
Name:ROULHAC, BECKY ELLEN
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:ELLEN
Last Name:ROULHAC
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 1:843 NC HIGHWAY 45 S
Mailing Address - Street 2:
Mailing Address - City:COFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27922-9100
Mailing Address - Country:US
Mailing Address - Phone:252-287-1846
Mailing Address - Fax:
Practice Address - Street 1:843 NC HIGHWAY 45 S
Practice Address - Street 2:
Practice Address - City:COFIELD
Practice Address - State:NC
Practice Address - Zip Code:27922-9100
Practice Address - Country:US
Practice Address - Phone:252-287-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant