Provider Demographics
NPI:1528383767
Name:ROELLI, AARON
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:ROELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15982 HWY 11
Mailing Address - Street 2:
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15982 HWY 11
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586-9748
Practice Address - Country:US
Practice Address - Phone:262-825-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1462-019225200000X
NMA-0592225200000X
WA60068760225200000X
IL160004463225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant