Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070012167 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070012167 | IL |
NPI | 1013263342 |
---|---|
Provider Name | Mrs. Jennifer Lauren Rosko |
First Address | Maywood, IL 60153-3328 |
Second Address | Oakbrook Terrace, IL 60181-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 24/07/2012 |