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Individual

MRS. THERESA MARY ROTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
21351 GENTRY DR, SUITE 125, STERLING, VA 20166-8510
(703) 851-8932
Mailing address
21386 FERNBROOK CT, BROADLANDS, VA 20148-4032
(703) 851-8932

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
847358
VA

Other

Enumeration date
11/19/2012
Last updated
04/08/2013
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