| NPI | 1629004536 |
|---|---|
| Former Name | JACQUELINE M ROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P8339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002230) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2015-03-02 |