Provider Demographics
NPI:1245389352
Name:DEL ROSARIO, JONATHAN SISON (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SISON
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:302 N PORT CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1222
Mailing Address - Country:US
Mailing Address - Phone:989-269-3045
Mailing Address - Fax:989-269-3045
Practice Address - Street 1:51 BROWN ST STE 5
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1159
Practice Address - Country:US
Practice Address - Phone:810-679-0078
Practice Address - Fax:810-679-4678
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650G610300OtherBCBS
0N97200OtherMEDICARE ID