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Individual

MARY C. ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.P.T.

Contact information

Practice address
3221 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-1222
(928) 910-7010
(928) 910-7011
Mailing address
2835 DUBLIN BLVD, COLORADO SPRINGS, CO 80918-1662
(719) 533-1318

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7074
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
102255329
OWCP
Enumeration date
08/11/2006
Last updated
02/24/2023
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