Individual
IVAN ROTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
501 SE 172ND AVE STE 110, VANCOUVER, WA 98684-9542
(360) 882-2778
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6530
OR
225100000X
Physical Therapist
Primary
PT60822016
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2096278
—
WA
Enumeration date
08/12/2011
Last updated
12/15/2022
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