Provider Demographics
NPI:1073994562
Name:ROZEBOOM, MALEEKA (DPT)
Entity Type:Individual
Prefix:
First Name:MALEEKA
Middle Name:
Last Name:ROZEBOOM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56138-4029
Mailing Address - Country:US
Mailing Address - Phone:605-212-0741
Mailing Address - Fax:
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-212-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1853225100000X
ND1972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist