Provider Demographics
NPI:1700821568
Name:ROEDIG, BETTINA (AT,C/L)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:ROEDIG
Suffix:
Gender:F
Credentials:AT,C/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4431
Mailing Address - Country:US
Mailing Address - Phone:239-430-8287
Mailing Address - Fax:
Practice Address - Street 1:4459 ROBIN AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4431
Practice Address - Country:US
Practice Address - Phone:239-430-8287
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 4292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer