Healthcare Provider Details

I. General information

NPI: 1801115787
Provider Name (Legal Business Name): SUSAN BETH ROTSKY ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 WAMPANOAG TRL
RIVERSIDE RI
02915-1231
US

IV. Provider business mailing address

71 IVANHOE AVE
SOMERSET MA
02726-2303
US

V. Phone/Fax

Practice location:
  • Phone: 401-433-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: