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General NPI Number Information
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NPI Number | 1578750386
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Entity Type | Individual
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Provider Name | RICHARD RAY ROSZELL LMT
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 1111 WESTGATE ST #115
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City | OAK PARK
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State | IL
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Zip | 60301-1007
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Country | US
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Telephone | 773-895-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 4249 N FRANCISCO AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2609
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Country | US
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Telephone | 773-895-0574
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | IL
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