Provider Demographics
NPI:1952720153
Name:ROEDER, DARCIE NAN (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:DARCIE
Middle Name:NAN
Last Name:ROEDER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:MISS
Other - First Name:DARCIE
Other - Middle Name:NAN
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPY
Mailing Address - Street 1:700 E. NORWEGIAN ST.
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901
Mailing Address - Country:US
Mailing Address - Phone:570-621-4256
Mailing Address - Fax:570-621-4954
Practice Address - Street 1:700 E NORWEGIAN ST.
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-621-4256
Practice Address - Fax:570-621-4954
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000270225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant