Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT019824 | PA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT21002 | FL |
NPI | 1013008564 |
---|---|
Provider Name | Kristi M Rosa |
First Address | West Chester, PA 19380-4278 |
Second Address | West Chester, PA 19380-4278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 03/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
888849300 | (05) | FL |