Individual
MR. BRIAN WILLIAM ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
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
Update your record
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