Provider Demographics
NPI:1992303499
Name:YOUSEFYAN, ROLENE (DPT)
Entity type:Individual
Prefix:
First Name:ROLENE
Middle Name:
Last Name:YOUSEFYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROLIN
Other - Middle Name:
Other - Last Name:YOUSEFYAN TAKIEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:307 FARLEY ST
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4325
Practice Address - Country:US
Practice Address - Phone:512-846-6960
Practice Address - Fax:512-846-6961
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61067139225100000X
IL070-026294225100000X
TX1356049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist