Provider Demographics
NPI:1417413477
Name:ROTH PT CLT
Entity Type:Organization
Organization Name:ROTH PT CLT
Other - Org Name:ROTH LYMPHEDEMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEBENROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:216-536-5288
Mailing Address - Street 1:225 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3094
Mailing Address - Country:US
Mailing Address - Phone:216-536-5288
Mailing Address - Fax:440-587-1149
Practice Address - Street 1:8180 BRECKSVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1353
Practice Address - Country:US
Practice Address - Phone:216-536-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty