NPI 1104424449

Mariah Roush, PTA

Practitioner Physical Therapy Assistant Lake Havasu City, AZ

Practice location

Address: 1948 Mesquite Ave STE 101, Lake Havasu City, AZ 86403-5777
Phone: (928) 854-4776
Fax: (928) 854-4857

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence PTA011894 (AZ)

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Registry record

NPI: 1104424449
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 Oct 2020
Record last updated: 9 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.