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General NPI Number Information
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NPI Number | 1245740604
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Entity Type | Individual
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Provider Name | JOHN ROSECRANS M.S. ED., ATC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 600 E WATER ST
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1472
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Country | US
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Telephone | 618-357-5013
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Fax |
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Provider Business Mailing Address
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Address Line | 305 PRINCE DR
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1911
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Country | US
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Telephone | 505-903-0170
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096003175
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License Number State | IL
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