Provider Demographics
NPI:1174983415
Name:ROEDER, CAROL (PT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SCHATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:558 SE 9TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2265
Mailing Address - Country:US
Mailing Address - Phone:541-410-3428
Mailing Address - Fax:541-640-5541
Practice Address - Street 1:558 SE 9TH ST STE 5
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2265
Practice Address - Country:US
Practice Address - Phone:541-410-3428
Practice Address - Fax:541-640-5541
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291240225100000X
OR63766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist