Provider Demographics
NPI:1538159025
Name:ROER, DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:ROER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:ROER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:29991 FERNHILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2031
Mailing Address - Country:US
Mailing Address - Phone:248-345-7110
Mailing Address - Fax:248-855-2063
Practice Address - Street 1:29991 FERNHILL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2031
Practice Address - Country:US
Practice Address - Phone:248-345-7110
Practice Address - Fax:248-855-2063
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDR003049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI320090860OtherTAX ID
MI650F32252OtherBCBS
MI0P3307001Medicare PIN
MI650F32252OtherBCBS
MI0N83410Medicare ID - Type Unspecified