Provider Demographics
NPI:1265973192
Name:ROTTET, KIMBERLY (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROTTET
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 CATAWISSA RD
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-5310
Mailing Address - Country:US
Mailing Address - Phone:570-225-6775
Mailing Address - Fax:
Practice Address - Street 1:50 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:NESQUEHONING
Practice Address - State:PA
Practice Address - Zip Code:18240-1310
Practice Address - Country:US
Practice Address - Phone:570-669-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant