Provider Demographics
NPI:1033940069
Name:CACERES, ROSSENERY (PT, DPT, AIB-VRC)
Entity type:Individual
Prefix:
First Name:ROSSENERY
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:PT, DPT, AIB-VRC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:CACERES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8682 N RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1457
Mailing Address - Country:US
Mailing Address - Phone:269-697-3724
Mailing Address - Fax:
Practice Address - Street 1:3630 TENNIS CT
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9502
Practice Address - Country:US
Practice Address - Phone:269-210-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist