Healthcare Provider Details

I. General information

NPI: 1114526464
Provider Name (Legal Business Name): CHRISTIAN ROTHLISBERGER B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WILLARD RD
RICHMOND VA
23294-3638
US

IV. Provider business mailing address

10357 SPENCER TRAIL PL
ASHLAND VA
23005-7475
US

V. Phone/Fax

Practice location:
  • Phone: 804-549-2376
  • Fax:
Mailing address:
  • Phone: 804-389-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: