Provider Demographics
NPI:1346623758
Name:ROTHROCK, RONI L (PT)
Entity type:Individual
Prefix:
First Name:RONI
Middle Name:L
Last Name:ROTHROCK
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 1:164 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2106
Mailing Address - Country:US
Mailing Address - Phone:814-861-8122
Mailing Address - Fax:814-861-4292
Practice Address - Street 1:164 GREENVIEW DR FL 2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2106
Practice Address - Country:US
Practice Address - Phone:814-861-8122
Practice Address - Fax:814-861-4292
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist