Active NPI
Anna Ruselle E. Roska-Dizon, RPT
- Physical Therapist
- Glenview, IL
National Provider Identifier
1366680894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070015745
- Practice address
- 3703 W Lake Ave
Suite 200
Glenview, IL 60026-5823 - Phone
- (847) 998-1188
- NPI assigned
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070015745 | IL | Primary |
Addresses
Primary practice location
3703 W Lake Ave
Suite 200
Glenview, IL 60026-5823
Mailing address
6655 West Pine Lake Dr
Tinley Park, IL 60477-4934
Phone (708) 263-5245
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070015745 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1366680894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6655 WEST PINE LAKE DR",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604774934",
"telephone_number": "708-263-5245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3703 W LAKE AVE",
"address_2": "SUITE 200",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600265823",
"telephone_number": "847-998-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSKA-DIZON",
"first_name": "ANNA RUSELLE",
"middle_name": "E.",
"name_prefix": "Mrs.",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-21",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070015745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.