Provider Demographics
NPI:1033254883
Name:ROSALIA, SANDRA A (NCLMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:ROSALIA
Suffix:
Gender:F
Credentials:NCLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6181
Mailing Address - Country:US
Mailing Address - Phone:630-768-3607
Mailing Address - Fax:
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6370
Practice Address - Country:US
Practice Address - Phone:630-768-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist