Provider Demographics
NPI:1396916904
Name:ROESLER, THERESA (LMT)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:ROESLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A ELK TERMINAL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-4200
Mailing Address - Country:US
Mailing Address - Phone:716-400-9626
Mailing Address - Fax:716-674-2969
Practice Address - Street 1:160 NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1525
Practice Address - Country:US
Practice Address - Phone:716-885-1581
Practice Address - Fax:716-885-2737
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist