Provider Demographics
NPI:1679740609
Name:ROTERT, RUTH E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:E
Last Name:ROTERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25523 442ND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-5519
Mailing Address - Country:US
Mailing Address - Phone:605-425-2582
Mailing Address - Fax:605-425-2582
Practice Address - Street 1:25523 442ND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-5519
Practice Address - Country:US
Practice Address - Phone:605-425-2582
Practice Address - Fax:605-425-2582
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics