Basic Information
| Provider Information | |||||||||
| NPI: | 1003143769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROESSNER | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 SOUTH 700 WEST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653692671 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 W WALNUT | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657892000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06003177A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.