Provider Demographics
NPI:1306029095
Name:RICK ROTHER, P.T., P.C.
Entity Type:Organization
Organization Name:RICK ROTHER, P.T., P.C.
Other - Org Name:RICHARD JOHN ROTHER JR PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROTHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:573-886-7411
Mailing Address - Street 1:411 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4437
Mailing Address - Country:US
Mailing Address - Phone:573-886-7411
Mailing Address - Fax:573-443-7246
Practice Address - Street 1:411 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4437
Practice Address - Country:US
Practice Address - Phone:573-886-7411
Practice Address - Fax:573-443-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty