Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070015389 | IL |
NPI | 1154647022 |
---|---|
Provider Name | Robert Rozanski |
First Address | Wheaton, IL 60187-4559 |
Second Address | Elmhurst, IL 60126-4980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2010 |
Last Update Date | 16/04/2010 |