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General NPI Number Information
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NPI Number | 1720129836
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Entity Type | Individual
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Provider Name | MONICA LYNNE ROEBUCK PTA
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 9370 UNION CEMETERY RD
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City | LOVELAND
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State | OH
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Zip | 45140-9577
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Country | US
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Telephone | 513-677-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 196 WILLOW GROVE DR
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City | SPRINGBORO
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State | OH
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Zip | 45066-7530
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Country | US
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Telephone | 937-239-1572
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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 | PTA04494
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License Number State | OH
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