Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | PT32129 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT32129 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT32129 | FL |
NPI | 1659895530 |
---|---|
Provider Name | Dr. Shane Rosonina |
First Address | Titusville, FL 32780-5113 |
Second Address | Titusville, FL 32796-2163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 20/04/2021 |