Provider Demographics
NPI:1245740604
Name:ROSECRANS, JOHN (MS ED, ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROSECRANS
Suffix:
Gender:M
Credentials:MS ED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PRINCE DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1911
Mailing Address - Country:US
Mailing Address - Phone:505-903-0170
Mailing Address - Fax:
Practice Address - Street 1:600 E WATER ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1472
Practice Address - Country:US
Practice Address - Phone:618-357-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960031752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer