1417258765 NPI number — STEFANIE HELENE ROTHERT LAC. L.M.T.

Table of content: STEFANIE HELENE ROTHERT LAC. L.M.T. (NPI 1417258765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417258765 NPI number — STEFANIE HELENE ROTHERT LAC. L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHERT
Provider First Name:
STEFANIE
Provider Middle Name:
HELENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC. L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PITTHAN
Provider Other First Name:
STEFANIE
Provider Other Middle Name:
HELENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.T.O.M.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417258765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11712 W 75TH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80005-5320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-880-9339
Provider Business Mailing Address Fax Number:
303-219-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8795 RALSTON RD STE 202C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80002-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-880-9339
Provider Business Practice Location Address Fax Number:
303-219-7174
Provider Enumeration Date:
11/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  1532 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: 2858 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)