Provider Demographics
NPI:1023146081
Name:ROSEWOOD PHYSICAL THERAPY LTD
Entity type:Organization
Organization Name:ROSEWOOD PHYSICAL THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEELY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,ATC
Authorized Official - Phone:618-259-9400
Mailing Address - Street 1:131 N BELLWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2088
Mailing Address - Country:US
Mailing Address - Phone:618-259-9400
Mailing Address - Fax:618-259-3334
Practice Address - Street 1:131 N BELLWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2088
Practice Address - Country:US
Practice Address - Phone:618-259-9400
Practice Address - Fax:618-259-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-005965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006010059OtherBLUE CROSS BLUE SHEILD OF
IL618774OtherHEALTHLINK
IL618774OtherHEALTHLINK
IL=========OtherTAX IDENTIFICATION