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General NPI Number Information
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NPI Number | 1003189333
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Entity Type | Individual
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Provider Name | KRISTYN MARGARET ROSENKOETTER DPT
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 15 N MAIN ST
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City | ALTAMONT
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State | IL
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Zip | 62411-1446
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Country | US
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Telephone | 618-881-0920
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Fax | 618-881-0919
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Provider Business Mailing Address
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Address Line | PO BOX 372
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City | MATTOON
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State | IL
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Zip | 61938-0372
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070018964
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License Number State | IL
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