Provider Demographics
NPI:1619398591
Name:ROSCOE, PATRICK (MS, ATC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ROSCOE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 E VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1976
Mailing Address - Country:US
Mailing Address - Phone:630-553-0349
Mailing Address - Fax:630-553-0439
Practice Address - Street 1:728 E VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1976
Practice Address - Country:US
Practice Address - Phone:630-553-0349
Practice Address - Fax:630-553-0439
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960033432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer