Provider Demographics
NPI:1437792124
Name:RAMOS, ROSELYN SEVILLA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:SEVILLA
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3762
Mailing Address - Country:US
Mailing Address - Phone:309-452-4406
Mailing Address - Fax:
Practice Address - Street 1:510 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3762
Practice Address - Country:US
Practice Address - Phone:309-452-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist