Provider Demographics
NPI:1811439615
Name:ROTH, VICKI (PT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2000 E LAYTON AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-6053
Mailing Address - Country:US
Mailing Address - Phone:414-747-8400
Mailing Address - Fax:414-747-8414
Practice Address - Street 1:2000 E LAYTON AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:ST FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-6053
Practice Address - Country:US
Practice Address - Phone:414-747-8400
Practice Address - Fax:414-747-8414
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4290-242251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports