1902120512 NPI number — ROESSLER PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902120512 NPI number — ROESSLER PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROESSLER PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902120512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6245 N 24TH PKY
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-997-7844
Provider Business Mailing Address Fax Number:
602-997-8020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 N 24TH PKWY
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-997-7844
Provider Business Practice Location Address Fax Number:
602-997-8020
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROESSLER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-997-7844

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1127 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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