MEDICARE: JESSICA SELF ROSNER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH4956	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51545232	OTHER	AL	BCBS AL

General Provider Information

NPI Number	:	1124158332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SELF ROSNER PT

Provider Business Mailing Address
First Line	:	3421 SOUTH SHADES CREST RD
Second Line	:	STE 107
City	:	HOOVER
State	:	AL
Zip	:	35244-3551
Country	:	US
Telephone Number	:	205-987-6501
Fax Number	:	205-987-6503

Provider Business Practice Location Address
First Line	:	3421 SOUTH SHADES CREST RD
Second Line	:	STE 107
City	:	HOOVER
State	:	AL
Zip	:	35244-3551
Country	:	US
Telephone Number	:	205-987-6501
Fax Number	:	205-987-6503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/25/2008

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Directions to “ JESSICA SELF ROSNER PT” Practice Location

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