Provider Demographics
NPI:1316251309
Name:ROTHENBACH, ANNE KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:KATHLEEN
Last Name:ROTHENBACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12044 N POINTE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7721
Mailing Address - Country:US
Mailing Address - Phone:616-451-2484
Mailing Address - Fax:616-451-4811
Practice Address - Street 1:12044 N POINTE LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7721
Practice Address - Country:US
Practice Address - Phone:616-451-4284
Practice Address - Fax:616-451-4811
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015299OtherLICENSE