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NPI Code Detail

MEDICARE: ROLLY BETITA OTERO PTA

MEDICARE: ROLLY BETITA OTERO PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantP67888NY

General Provider Information

NPI Number : 1316171093
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROLLY BETITA OTERO PTA
Provider Business Mailing Address
First Line : 274 OGDEN AVE
Second Line : BSMNT
City : JERSEY CITY
State : NJ
Zip : 07307-1209
Country : US
Telephone Number : 201-658-1529
Fax Number :
Provider Business Practice Location Address
First Line : 729 PELHAM PKWY N
Second Line :
City : BRONX
State : NY
Zip : 10467-9506
Country : US
Telephone Number : 718-944-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2009
Last Update Date : 05/08/2009

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