Basic Information
| Provider Information | |||||||||
| NPI: | 1780131698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STROM | ||||||||
| FirstName: | AARON | ||||||||
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| Credential: | CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5875 E RIVERSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611144937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153817431 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5929 EAST RIVERSIDE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611144937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153989491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Z00000X | 213000299 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
No ID Information.