Provider Demographics
NPI:1518285048
Name:ROSAL, TERRY MICHAEL RAMOS (PT)
Entity Type:Individual
Prefix:MR
First Name:TERRY MICHAEL
Middle Name:RAMOS
Last Name:ROSAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:RAMOS
Other - Last Name:ROSAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:386 CLUBHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4621 WEDGEWOOD COURT
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532
Practice Address - Country:US
Practice Address - Phone:630-999-1040
Practice Address - Fax:630-925-7412
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022971225100000X
NY031134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist