Provider Demographics
NPI:1649451246
Name:ROETHLER, AMANDA MARIE
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MARIE
Last Name:ROETHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TAFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14750 CEDAR AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4506
Mailing Address - Country:US
Mailing Address - Phone:952-431-3133
Mailing Address - Fax:952-431-7788
Practice Address - Street 1:14750 CEDAR AVE
Practice Address - Street 2:STE 104
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4506
Practice Address - Country:US
Practice Address - Phone:952-431-3133
Practice Address - Fax:952-431-7788
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist