Provider Demographics
NPI:1912538786
Name:ROSADO, EVIE (LMT)
Entity Type:Individual
Prefix:
First Name:EVIE
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 PHOENIX LN
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8417
Mailing Address - Country:US
Mailing Address - Phone:815-325-2376
Mailing Address - Fax:
Practice Address - Street 1:711 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2540
Practice Address - Country:US
Practice Address - Phone:815-325-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.015397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA89150OtherFL DEPARTMENT OF HEALTH
IL227.015397OtherILDPH MASSAGE THERAPIST LICENSE NUMBER
INMT21906775OtherINDIANA PROFESSIONAL LICENSING AGENCY