Provider Demographics
NPI:1588321566
Name:ROTHEY, BRIAN KENNETH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:ROTHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11426 60TH LN N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2011
Mailing Address - Country:US
Mailing Address - Phone:727-729-2905
Mailing Address - Fax:
Practice Address - Street 1:11426 60TH LN N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2011
Practice Address - Country:US
Practice Address - Phone:727-729-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services