Provider Demographics
NPI:1477537884
Name:ROLLER BACHMANN, PAULA S (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:ROLLER BACHMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:R
Other - Last Name:BACHMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5777 E MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:5777 E MAYO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-4502
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748783Medicaid
AZ650026142OtherRAILROAD MEDICARE
AZ748783Medicaid
AZZ143333Medicare PIN
AZZ73085Medicare PIN