Individual
CHRISTIAN WILLIAM ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, CHT
Contact information
Practice address
301 S LAFAYETTE ST, SOUTH LYON, MI 48178-1407
(248) 486-1110
(248) 486-3318
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501000577
MI
2251H1200X
Hand Physical Therapist
5501000577
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H71069
BCBSMI
MI
05
—
4709236
—
MI
Enumeration date
08/17/2005
Last updated
11/11/2014
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