Healthcare Provider Details

I. General information

NPI: 1548660608
Provider Name (Legal Business Name): BRADLEY ROTROFF SOLLARS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 COLLEGE AVE
COLUMBUS OH
43209-2827
US

IV. Provider business mailing address

232 E MARKET ST
WASHINGTON COURT HOUSE OH
43160-1348
US

V. Phone/Fax

Practice location:
  • Phone: 614-231-4900
  • Fax:
Mailing address:
  • Phone: 740-505-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTA.07710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: