Provider Demographics
NPI:1225489495
Name:ROTTINGHAUS, MAGGIE ROSEANN (PTA)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ROSEANN
Last Name:ROTTINGHAUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:ROSEANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N11161 NIBLER RD
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-8329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1970 NAVAJO ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-420-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2115410225200000X
WI2495-19225200000X
IA005114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225489495Medicaid