Provider Demographics
NPI:1841322377
Name:ROTH, VALERIE (PT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BARKER ST
Mailing Address - Street 2:#204
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1710
Mailing Address - Country:US
Mailing Address - Phone:914-244-9077
Mailing Address - Fax:
Practice Address - Street 1:3535 HILL BLVD
Practice Address - Street 2:SUITE P
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1293
Practice Address - Country:US
Practice Address - Phone:914-962-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002065-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist