Provider Demographics
NPI:1861818866
Name:ROARK, BILLIE (PT)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:VICCO
Mailing Address - State:KY
Mailing Address - Zip Code:41773-0518
Mailing Address - Country:US
Mailing Address - Phone:606-476-9231
Mailing Address - Fax:
Practice Address - Street 1:1270 RT. FK. MONTGOMERY CREEK RD.
Practice Address - Street 2:
Practice Address - City:VICCO
Practice Address - State:KY
Practice Address - Zip Code:41773
Practice Address - Country:US
Practice Address - Phone:606-233-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic