Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 075402 | IA |
NPI | 1245606623 |
---|---|
Provider Name | Alicia Roesger |
First Address | Muscatine, IA 52761-2612 |
Second Address | Muscatine, IA 52761-2612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 19/08/2015 |