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General NPI Number Information
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NPI Number | 1821318460
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Entity Type | Individual
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Provider Name | ELIZABETH ANN ROTH PT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2010
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 3295 WESTERDOLL AVE
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-290-3672
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Fax |
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Provider Business Mailing Address
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Address Line | 3295 WESTERDOLL AVE
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City | LOVELAND
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State | CO
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Zip | 80538-7256
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Country | US
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Telephone | 970-290-3672
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 0004430
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License Number State | CO
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