Provider Demographics
NPI:1861037673
Name:ROTHENBERGER, SALENA
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
Last Name:ROTHENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 HOLLYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4715
Mailing Address - Country:US
Mailing Address - Phone:936-463-0272
Mailing Address - Fax:
Practice Address - Street 1:1010 HOLLYBERRY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4715
Practice Address - Country:US
Practice Address - Phone:936-463-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator