Provider Demographics
NPI:1922692284
Name:RORER, CARLY MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:MARIE
Last Name:RORER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 S YOUNG CT
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4197
Mailing Address - Country:US
Mailing Address - Phone:909-810-8282
Mailing Address - Fax:
Practice Address - Street 1:2548 S YOUNG CT
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4197
Practice Address - Country:US
Practice Address - Phone:909-810-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA294027OtherPHYSICAL THERAPY LICENSE NUMBER