Provider Demographics
NPI:1902120512
Name:ROESSLER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ROESSLER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-997-7844
Mailing Address - Street 1:6245 N 24TH PKY
Mailing Address - Street 2:STE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2029
Mailing Address - Country:US
Mailing Address - Phone:602-997-7844
Mailing Address - Fax:602-997-8020
Practice Address - Street 1:6245 N 24TH PKWY
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2024
Practice Address - Country:US
Practice Address - Phone:602-997-7844
Practice Address - Fax:602-997-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty