Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | IL |
NPI | 1366115032 |
---|---|
Provider Name | Caitlin Rosentreter |
First Address | Edwardsville, IL 62025-3178 |
Second Address | Jerseyville, IL 62052-2361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |