Provider Demographics
NPI:1417258765
Name:ROTHERT, STEFANIE HELENE (LAC LMT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:HELENE
Last Name:ROTHERT
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:HELENE
Other - Last Name:PITTHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSTOM
Mailing Address - Street 1:11712 W 75TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5320
Mailing Address - Country:US
Mailing Address - Phone:303-880-9339
Mailing Address - Fax:303-219-7174
Practice Address - Street 1:8795 RALSTON RD STE 202C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2364
Practice Address - Country:US
Practice Address - Phone:303-880-9339
Practice Address - Fax:303-219-7174
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1532171100000X, 171100000X
CO2858225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist