Healthcare Provider Details

I. General information

NPI: 1700056983
Provider Name (Legal Business Name): MICHELLE L ROTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WASHINGTON AVE.
ALBANY NY
12203
US

IV. Provider business mailing address

550 FRONTAGE RD SUITE #2415
NORTHFIELD IL
60093-1202
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-7831
  • Fax: 518-456-7597
Mailing address:
  • Phone: 847-441-5593
  • Fax: 847-441-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0298831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: