Individual ProviderKathleen A RothPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address8855 Viscount Blvd Ste E, El Paso, TX 79925-5812(915) 593-8555(915) 351-6600PECOS EnrollmentBased on the most recent information from CMS, provider Kathleen A Roth does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1245345032Provider TypeIndividualFull NameRoth, Kathleen ATitleMrs.CredentialP.T.GenderFemaleSole ProprietorNoEnumeration Date8/20/2006Last Updated2/3/2020Contact InformationPractice LocationPractice Address8855 Viscount Blvd Ste E, El Paso, TX 79925-5812Phone(915) 593-8555Fax(915) 593-2422Mailing LocationMailing Address4849 N Mesa St Ste 201, El Paso, TX 79912-5919Phone(915) 351-6600Fax(915) 351-6601Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1039188TexasProvider IdentifiersIDDescriptionIssuerID062988302DescriptionMedicaidIssuerUnlistedTexasID83402TDescriptionOtherIssuerBLUECROSS AND BLUESHIELDTexas