Individual
MR. JONATHAN SISON DEL ROSARIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
51 BROWN ST STE 5, CROSWELL, MI 48422-1159
(810) 679-0078
(810) 679-4678
Mailing address
302 N PORT CRESCENT ST, BAD AXE, MI 48413-1222
(989) 269-3045
(989) 269-3045
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501007571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N97200
MEDICARE ID
—
01
—
650G610300
BCBS
MI
Enumeration date
01/09/2007
Last updated
06/27/2008
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