Provider Demographics
NPI:1043774268
Name:ROTH, STEPHANIE RAMSEY (MES)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RAMSEY
Last Name:ROTH
Suffix:
Gender:F
Credentials:MES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4406 MOREHOUSE TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7767
Mailing Address - Country:US
Mailing Address - Phone:804-874-2686
Mailing Address - Fax:
Practice Address - Street 1:2912 OAK LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3998
Practice Address - Country:US
Practice Address - Phone:804-585-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist