MEDICARE: ANGELA S ROTNER MPT

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	7284	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790906147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA S ROTNER MPT

Provider Business Mailing Address
First Line	:	1555 RIDGE WEST DR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-4665
Country	:	US
Telephone Number	:	970-213-9861
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 RIDGE WEST DR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-4665
Country	:	US
Telephone Number	:	970-213-9861
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	06/30/2015

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