Provider Demographics
NPI:1386960995
Name:ROSHAU, KEVIN JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:ROSHAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-328-0650
Mailing Address - Fax:661-328-0654
Practice Address - Street 1:2601 OSWELL ST.
Practice Address - Street 2:STE 105
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-871-5908
Practice Address - Fax:661-871-5647
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist