MEDICARE: WALDO R ROTH 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
1	225100000X	Physical Therapist	0562	NV

General Provider Information

NPI Number	:	1871998088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALDO R ROTH PT

Provider Business Mailing Address
First Line	:	2121 MARSH TERN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2807
Country	:	US
Telephone Number	:	702-285-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MARSH TERN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2807
Country	:	US
Telephone Number	:	702-285-4840
Fax Number	:

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

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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Directions to “ WALDO R ROTH PT” Practice Location

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