Provider Demographics
NPI:1073786109
Name:ROZENBERG, AMY GRACE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GRACE
Last Name:ROZENBERG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRIAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7608
Mailing Address - Country:US
Mailing Address - Phone:847-272-8949
Mailing Address - Fax:
Practice Address - Street 1:2401 BRIAN DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7608
Practice Address - Country:US
Practice Address - Phone:847-272-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist