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NPI Code Detail

MEDICARE: ANTHONY JOE ROFFINE M.M.T.

MEDICARE: ANTHONY JOE ROFFINE M.M.T.
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
1225700000XMassage Therapist1470AR

General Provider Information

NPI Number : 1346561693
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY JOE ROFFINE M.M.T.
Provider Business Mailing Address
First Line : 6108 S 31ST ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-7555
Country : US
Telephone Number : 479-648-1107
Fax Number : 479-646-0416
Provider Business Practice Location Address
First Line : 6108 S 31ST ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-7555
Country : US
Telephone Number : 479-648-1107
Fax Number : 479-646-0416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2010
Last Update Date : 06/21/2010

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