Healthcare Provider Details

I. General information

NPI: 1043774268
Provider Name (Legal Business Name): STEPHANIE RAMSEY ROTH MES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 OAK LAKE BLVD
MIDLOTHIAN VA
23112-3998
US

IV. Provider business mailing address

4406 MOREHOUSE TER
CHESTERFIELD VA
23832-7767
US

V. Phone/Fax

Practice location:
  • Phone: 804-585-6723
  • Fax:
Mailing address:
  • Phone: 804-874-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: