Provider Demographics
NPI:1346465069
Name:ROSENAU, JODI DAWN (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:DAWN
Last Name:ROSENAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-8804
Mailing Address - Country:US
Mailing Address - Phone:724-456-7913
Mailing Address - Fax:724-646-0796
Practice Address - Street 1:524 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-8804
Practice Address - Country:US
Practice Address - Phone:724-456-7913
Practice Address - Fax:724-646-0796
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012373L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist