Carly Paige Roark, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10261

Practice address

1450 Claiborne Ave
Shreveport, LA 71103-4204

Phone

(318) 813-2970

Fax

(318) 813-2981

NPI assigned

Jul 25, 2019

Last updated

Feb 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment NPD
• Quad C Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Many, LA
  • NPI 1831595677
  Medicare reassignment NPD
• Quad C Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Ville Platte, LA
  • NPI 1003770181

  Physical Therapist

  NPD
• Quad C Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Leesville, LA
  • NPI 1740907310
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1528612850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29185 HIGHWAY 191",
            "city": "MANY",
            "state": "LA",
            "postal_code": "714496313",
            "telephone_number": "318-590-9140",
            "fax_number": "318-590-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CLAIBORNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034204",
            "telephone_number": "318-813-2970",
            "fax_number": "318-813-2981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29185 Highway 191",
            "address_purpose": "LOCATION",
            "city": "Many",
            "state": "LA",
            "postal_code": "714496313",
            "country_code": "US",
            "telephone_number": "318-590-9140",
            "fax_number": "318-590-9141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROARK",
        "first_name": "CARLY",
        "middle_name": "PAIGE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-25",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": "10261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174173",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Road2Success LLC
• Road2Success LLC
• Roan Counseling, LLC
• Connor Roan
• Kara King Roan, MOT, LOTR
• Kitty A. Roark
• Shetwan Lynette Roberison
• Roberson Transportation of Shreveport LLC
• Anthony Roberson Jr.
• Ashley-Kate Roberson, APRN

• Physical Therapist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.