MEDICARE: SUZANNE JOYCE ROH-FREEMAN 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	PT14692	CA

General Provider Information

NPI Number	:	1922083013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE JOYCE ROH-FREEMAN PT

Provider Business Mailing Address
First Line	:	200 NEWPORT CENTER DR
Second Line	:	#213
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7501
Country	:	US
Telephone Number	:	714-847-3800
Fax Number	:	714-847-1413

Provider Business Practice Location Address
First Line	:	6930 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5316
Country	:	US
Telephone Number	:	714-847-3800
Fax Number	:	714-847-1413

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	04/15/2015

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