MEDICARE: STEPHANIE ROTH PT

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	225100000X	Physical Therapist	12778	WI

General Provider Information

NPI Number	:	1790176675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ROTH PT

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 ORBITING DR
Second Line	:
City	:	MOSINEE
State	:	WI
Zip	:	54455-1763
Country	:	US
Telephone Number	:	715-693-9188
Fax Number	:

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

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	09/20/2023

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Directions to “ STEPHANIE ROTH PT” Practice Location

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