Individual
MR. BRIAN WILLIAM ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
510 N GRANDSTAFF DR, AUBURN, IN 46706
(260) 927-9270
(260) 927-9272
Mailing address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007103A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350992
ANTHEM BCBS
IN
01
—
1424
PHP
IN
05
—
200189290A
—
IN
01
—
35179001202
CARESOURCE
IN
01
—
4423623
AETNA
IN
01
—
N299947
HARMONY
IN
Enumeration date
11/27/2006
Last updated
04/08/2010
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