Provider Demographics
NPI:1003865148
Name:ROTEN, ROBERT GLENN (LPT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GLENN
Last Name:ROTEN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6109
Mailing Address - Country:US
Mailing Address - Phone:806-785-7900
Mailing Address - Fax:806-785-7909
Practice Address - Street 1:6801 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6109
Practice Address - Country:US
Practice Address - Phone:806-785-7900
Practice Address - Fax:806-785-7909
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2298OtherBLUE CROSS/BLUE SHIELD
TX8T2298OtherBLUE CROSS/BLUE SHIELD