Provider Demographics
NPI:1396183794
Name:TOMOL, ROSALIE A
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:A
Last Name:TOMOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 SUNFISH PT
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3637
Mailing Address - Country:US
Mailing Address - Phone:503-806-0025
Mailing Address - Fax:
Practice Address - Street 1:733 SUNFISH PT
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3637
Practice Address - Country:US
Practice Address - Phone:503-806-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist