Healthcare Provider Details

I. General information

NPI: 1992303499
Provider Name (Legal Business Name): ROLENE YOUSEFYAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROLIN YOUSEFYAN TAKIEH

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 FARLEY ST
HUTTO TX
78634-4325
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 512-846-6960
  • Fax: 512-846-6961
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61067139
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-026294
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1356049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: