Healthcare Provider Details

I. General information

NPI: 1144968769
Provider Name (Legal Business Name): HILLARY LYNN ROSENQUIST PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 RISEN SON BLVD
COUNCIL BLUFFS IA
51503-1911
US

IV. Provider business mailing address

4433 S 133RD ST UNIT 45307
OMAHA NE
68145-0195
US

V. Phone/Fax

Practice location:
  • Phone: 712-366-9655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number077907
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: