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NPI Code Detail

MEDICARE: JULIE ROTH PTA

MEDICARE: JULIE ROTH 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 Assistant957NE

General Provider Information

NPI Number : 1790094845
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ROTH PTA
Provider Business Mailing Address
First Line : 1914 ATLAS DR
Second Line :
City : PAPILLION
State : NE
Zip : 68133-3400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1120 WALNUT ST
Second Line :
City : NORTH BEND
State : NE
Zip : 68649-5012
Country : US
Telephone Number : 402-652-3242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2010
Last Update Date : 10/06/2010

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