Provider Demographics
NPI:1972978989
Name:ROSENBAUM, PARICIA (PTA)
Entity type:Individual
Prefix:
First Name:PARICIA
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 W CHALLACOMBE RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:IL
Mailing Address - Zip Code:61528-9534
Mailing Address - Country:US
Mailing Address - Phone:309-657-3759
Mailing Address - Fax:
Practice Address - Street 1:7021 W CHALLACOMBE RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:IL
Practice Address - Zip Code:61528-9534
Practice Address - Country:US
Practice Address - Phone:309-657-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant