Provider Demographics
NPI:1255803805
Name:NESTER, ROXANNE MICHELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:MICHELLE
Last Name:NESTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:MICHELLE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 DALE DR
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-9060
Mailing Address - Country:US
Mailing Address - Phone:484-645-4323
Mailing Address - Fax:
Practice Address - Street 1:5 DALE DR
Practice Address - Street 2:
Practice Address - City:MOHRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19541-9060
Practice Address - Country:US
Practice Address - Phone:484-645-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant