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NPI Code Detail

MEDICARE: MS. VICKIE LYNN ROESER PT

MEDICARE:  MS. VICKIE LYNN ROESER  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
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1851360804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICKIE LYNN ROESER PT
Provider Business Mailing Address
First Line : 5354 N LAKEWOOD RD
Second Line :
City : OLNEY
State : IL
Zip : 62450-4314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 E LOCUST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2553
Country : US
Telephone Number : 618-395-6031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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Directions to “ MS. VICKIE LYNN ROESER PT” Practice Location

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