Provider Demographics
NPI:1407874498
Name:ROTH, AIMEE ELIZABETH (ATC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:ROTH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 DUBLIN LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7876
Mailing Address - Country:US
Mailing Address - Phone:317-989-7387
Mailing Address - Fax:
Practice Address - Street 1:2650 HOME AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3103
Practice Address - Country:US
Practice Address - Phone:317-989-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001135A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer