Provider Demographics
NPI:1700950961
Name:PAUL D. ROSSMAN PTSC
Entity Type:Organization
Organization Name:PAUL D. ROSSMAN PTSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-963-6330
Mailing Address - Street 1:3970 N OAKLAND AVE
Mailing Address - Street 2:703
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2265
Mailing Address - Country:US
Mailing Address - Phone:414-963-6330
Mailing Address - Fax:414-963-6331
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:703
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-963-6330
Practice Address - Fax:414-963-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3947-024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700950961Medicare UPIN