Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 02153 | IA |
NPI | 1003256728 |
---|---|
Provider Name | Mr. Michael L Rohde |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Atlantic, IA 50022-1961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 20/12/2016 |