Provider Demographics
NPI:1649250143
Name:ROTHER, RICHARD JOHN JR (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:ROTHER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:ROTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:411 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4437
Mailing Address - Country:US
Mailing Address - Phone:573-886-7411
Mailing Address - Fax:573-443-7246
Practice Address - Street 1:411 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4437
Practice Address - Country:US
Practice Address - Phone:573-886-7411
Practice Address - Fax:573-443-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist