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NPI Code Detail

MEDICARE: MRS. GRETA P. ROOF PT

MEDICARE: MRS. GRETA P. ROOF PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical Therapist8208TN
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1093836595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRETA P. ROOF PT
Provider Business Mailing Address
First Line : 815 TRIPLETT ST
Second Line :
City : OWENSBORO
State : KY
Zip : 42303-3564
Country : US
Telephone Number : 706-834-5172
Fax Number :
Provider Business Practice Location Address
First Line : 815 TRIPLETT ST
Second Line :
City : OWENSBORO
State : KY
Zip : 42303-3564
Country : US
Telephone Number : 270-683-4517
Fax Number : 270-852-1491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 12/17/2024

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