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General NPI Number Information
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NPI Number | 1629190053
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Entity Type | Individual
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Provider Name | MICHAEL JOHN ROTACH P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 715 E KING ST
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City | SEAFORD
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State | DE
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Zip | 19973-3505
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Country | US
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Telephone | 302-628-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 117 HIGH ST APT 3
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City | SEAFORD
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State | DE
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Zip | 19973-3928
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Country | US
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Telephone | 302-430-8024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | J2-0000326
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License Number State | DE
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