MEDICARE: JARED ROZNOWSKI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		WI

General Provider Information

NPI Number	:	1366180432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED ROZNOWSKI DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	1135 PRAIRIE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-3973
Country	:	US
Telephone Number	:	262-886-6780
Fax Number	:	262-886-6710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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Directions to “ JARED ROZNOWSKI DPT” Practice Location

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