Provider Demographics
NPI:1144733445
Name:ROEHR, BETH ANN
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:ROEHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LAKEWOOD CIR STE A104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2667
Mailing Address - Country:US
Mailing Address - Phone:719-332-4689
Mailing Address - Fax:719-282-1449
Practice Address - Street 1:411 LAKEWOOD CIR STE A104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2667
Practice Address - Country:US
Practice Address - Phone:719-332-4689
Practice Address - Fax:719-282-1449
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist