Provider Demographics
NPI:1275738809
Name:AVES, ROSSI KAY (NCTMB, LMT)
Entity Type:Individual
Prefix:MS
First Name:ROSSI
Middle Name:KAY
Last Name:AVES
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S 7TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-9392
Mailing Address - Country:US
Mailing Address - Phone:815-561-0076
Mailing Address - Fax:815-561-0072
Practice Address - Street 1:1201 S 7TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-9392
Practice Address - Country:US
Practice Address - Phone:815-561-0076
Practice Address - Fax:815-561-0072
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
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