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General NPI Number Information
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NPI Number | 1003143769
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Entity Type | Individual
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Provider Name | JOANN CATHERINE ROESSNER PTA
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Gender | Female
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 910 W WALNUT
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City | ALBANY
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State | IN
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Zip | 47320
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Country | US
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Telephone | 765-789-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 SOUTH 700 WEST
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City | PORTLAND
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State | IN
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Zip | 47371
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Country | US
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Telephone | 765-369-2671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003177A
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License Number State | IN
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