Provider Demographics
NPI:1639732654
Name:ROTHERMEL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROTHERMEL
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 1:1018 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5314
Mailing Address - Country:US
Mailing Address - Phone:337-384-4233
Mailing Address - Fax:
Practice Address - Street 1:817 N AVENUE K
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3850
Practice Address - Country:US
Practice Address - Phone:337-783-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program