Provider Demographics
NPI:1922314475
Name:BATES, ROSE ANN I (PT)
Entity Type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:ANN
Last Name:BATES
Suffix:I
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 1:631 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2454
Mailing Address - Country:US
Mailing Address - Phone:765-606-0078
Mailing Address - Fax:
Practice Address - Street 1:40 N 64TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3808
Practice Address - Country:US
Practice Address - Phone:618-606-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist