Provider Demographics
NPI:1366577678
Name:ROEN, DEBORAH J (LPT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:ROEN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 101-175
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8009
Mailing Address - Country:US
Mailing Address - Phone:803-981-4054
Mailing Address - Fax:803-802-2264
Practice Address - Street 1:1750 HIGHWAY 160 W
Practice Address - Street 2:SUITE 101-175
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8009
Practice Address - Country:US
Practice Address - Phone:803-981-4054
Practice Address - Fax:803-802-2264
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics