MEDICARE: CARSON ROSHONE

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	225100000X	Physical Therapist	133404	IA

General Provider Information

NPI Number	:	1467330233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON ROSHONE

Provider Business Mailing Address
First Line	:	2280 PEORIA AVE
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1274
Country	:	US
Telephone Number	:	712-320-0832
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 PEORIA AVE
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1274
Country	:	US
Telephone Number	:	712-320-0832
Fax Number	:

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

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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Directions to “ CARSON ROSHONE ” Practice Location

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