Provider Demographics
NPI:1760738561
Name:ROSENTHAL, ANNE MAE (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MAE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S. MAPLE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304
Mailing Address - Country:US
Mailing Address - Phone:312-504-7222
Mailing Address - Fax:
Practice Address - Street 1:1118 W FULTON MARKET
Practice Address - Street 2:#403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1282
Practice Address - Country:US
Practice Address - Phone:708-660-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist