Provider Demographics
NPI:1215234562
Name:PEDRO, ROSELLE ESPERA
Entity type:Individual
Prefix:MS
First Name:ROSELLE
Middle Name:ESPERA
Last Name:PEDRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 OLD CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-0635
Mailing Address - Country:US
Mailing Address - Phone:815-733-5165
Mailing Address - Fax:
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-540-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017790225100000X
NY026916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist