Provider Demographics
NPI:1457394355
Name:ROTHBAUER, JAMES J (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:ROTHBAUER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 PLAUDIT PL STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2429
Mailing Address - Country:US
Mailing Address - Phone:859-264-0512
Mailing Address - Fax:859-264-0595
Practice Address - Street 1:1868 PLAUDIT PL STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:502-426-2221
Practice Address - Fax:502-426-2210
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT002994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87001392Medicaid