Provider Demographics
NPI:1457740631
Name:ROACH, BRITTNEY (RT (R))
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38777 6 MILE RD
Mailing Address - Street 2:#209
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2694
Mailing Address - Country:US
Mailing Address - Phone:734-452-0395
Mailing Address - Fax:877-414-9925
Practice Address - Street 1:38777 6 MILE RD
Practice Address - Street 2:#209
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2694
Practice Address - Country:US
Practice Address - Phone:734-452-0395
Practice Address - Fax:877-414-9925
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506701247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist