MEDICARE: BRYAN C ROEHR LCPO

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
1	224P00000X	Prosthetist	PS00000447	WA
2	222Z00000X	Orthotist	OI00000446	WA

General Provider Information

NPI Number	:	1619128170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN C ROEHR LCPO

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-4139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-4139
Country	:	US
Telephone Number	:	206-616-9997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	12/06/2023

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Directions to “ BRYAN C ROEHR LCPO” Practice Location

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