Healthcare Provider Details

I. General information

NPI: 1588025209
Provider Name (Legal Business Name): GRACE ROSENBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 MCKENZIE ST
SANTA FE NM
87501-1883
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 505-428-0427
  • Fax: 505-428-0399
Mailing address:
  • Phone: 812-759-7451
  • Fax: 812-759-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006426
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12749-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: