MEDICARE: MRS. DEBORAH J ROEN LPT

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
1	2251P0200X	Pediatric Physical Therapist	5149	SC

General Provider Information

NPI Number	:	1366577678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH J ROEN LPT

Provider Business Mailing Address
First Line	:	1750 HIGHWAY 160 W
Second Line	:	SUITE 101-175
City	:	FORT MILL
State	:	SC
Zip	:	29708-8009
Country	:	US
Telephone Number	:	803-981-4054
Fax Number	:	803-802-2264

Provider Business Practice Location Address
First Line	:	1750 HIGHWAY 160 W
Second Line	:	SUITE 101-175
City	:	FORT MILL
State	:	SC
Zip	:	29708-8009
Country	:	US
Telephone Number	:	803-981-4054
Fax Number	:	803-802-2264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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