Provider Demographics
NPI:1427347434
Name:ROTH, AARON (DPT)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:ROTH
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 1:1415 E 16TH ST
Mailing Address - Street 2:2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6607
Mailing Address - Country:US
Mailing Address - Phone:718-336-0212
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:1498 E 4TH ST
Practice Address - Street 2:2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6333
Practice Address - Country:US
Practice Address - Phone:718-336-0212
Practice Address - Fax:718-336-0212
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist