Provider Demographics
NPI:1720129836
Name:ROEBUCK, MONICA LYNNE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LYNNE
Last Name:ROEBUCK
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 1:196 WILLOW GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7530
Mailing Address - Country:US
Mailing Address - Phone:937-239-1572
Mailing Address - Fax:
Practice Address - Street 1:9370 UNION CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9577
Practice Address - Country:US
Practice Address - Phone:513-677-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA04494225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04494-PTAOtherOHIO PTA LICENSE