Provider Demographics
NPI:1952895575
Name:ROTHERT, CATHLEEN MARIE
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE
Last Name:ROTHERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-0578
Mailing Address - Country:US
Mailing Address - Phone:847-530-5063
Mailing Address - Fax:
Practice Address - Street 1:1873 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2158
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.002969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-002969OtherPHYSICAL THERAPY LICENSE