Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070018964 | IL |
NPI | 1003189333 |
---|---|
Provider Name | Kristyn Margaret Rosenkoetter |
First Address | Effingham, IL 62401-1619 |
Second Address | Effingham, IL 62401-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 21/08/2014 |