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General NPI Number Information
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NPI Number | 1811577364
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Entity Type | Organization
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Legal Business Name | ROEDERER REHABILITATION AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 171 S 2ND ST
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City | BYESVILLE
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State | OH
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Zip | 43723-1303
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Country | US
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Telephone | 740-685-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 171 S 2ND ST
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City | BYESVILLE
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State | OH
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Zip | 43723-1303
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Country | US
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Telephone | 740-685-9800
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | TRENT ROEDERER
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Credential | DPT
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Telephone | 740-685-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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