Provider Demographics
NPI:1013263342
Name:ROSKO, JENNIFER LAUREN (PT, CLT-LANA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:ROSKO
Suffix:
Gender:F
Credentials:PT, CLT-LANA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:GOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, CLT-LANA
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:630-953-6778
Mailing Address - Fax:630-953-6793
Practice Address - Street 1:1S260 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3941
Practice Address - Country:US
Practice Address - Phone:630-953-6778
Practice Address - Fax:630-953-6793
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700121672251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic