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General NPI Number Information
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NPI Number | 1366115032
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Entity Type | Individual
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Provider Name | CAITLIN ROSENTRETER
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 1001 S STATE ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2361
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Country | US
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Telephone | 618-498-6496
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Fax |
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Provider Business Mailing Address
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Address Line | 230 BELDEN DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3178
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Country | US
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Telephone | 217-556-9207
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State | IL
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