Provider Demographics
NPI:1811207319
Name:ROHR, MICOL REBECCA (LMP)
Entity Type:Individual
Prefix:
First Name:MICOL
Middle Name:REBECCA
Last Name:ROHR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 CRARY AVE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1158
Mailing Address - Country:US
Mailing Address - Phone:253-228-2718
Mailing Address - Fax:
Practice Address - Street 1:5029 CRARY AVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1158
Practice Address - Country:US
Practice Address - Phone:253-228-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60179240172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist