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NPI Code Detail

MEDICARE: JEROME ALEGADO ROSALES P.T.

MEDICARE:   JEROME ALEGADO ROSALES  P.T.
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
1225100000XPhysical Therapist05005566AIN

General Provider Information

NPI Number : 1184869703
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME ALEGADO ROSALES P.T.
Provider Business Mailing Address
First Line : 7614 COVINGTON HOLLOW LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6153
Country : US
Telephone Number : 260-432-8344
Fax Number :
Provider Business Practice Location Address
First Line : 7614 COVINGTON HOLLOW LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6153
Country : US
Telephone Number : 260-432-8344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2008
Last Update Date : 12/10/2008

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Directions to “ JEROME ALEGADO ROSALES P.T.” Practice Location

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