Individual
STACY ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7554
(307) 778-7369
Mailing address
5301 POTOMAC ST, CHEYENNE, WY 82001-2220
(307) 778-7554
(307) 778-7369
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1136
ND
Other
Enumeration date
04/21/2006
Last updated
07/08/2007
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