Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 02575R | LA |
N | 2251C2600X | Cardiopulmonary | 02575R | LA |
N | 2251E1200X | Ergonomics | 02575R | LA |
N | 225XE1200X | Ergonomics | 02575R | LA |
N | 2251E1300X | Electrophysiology, Clinical | 02575R | LA |
N | 2251G0304X | Physical Therapist - Geriatrics | 02575R | LA |
N | 2251H1200X | Hand | 02575R | LA |
N | 2251H1300X | Human Factors | 02575R | LA |
N | 225XH1300X | Human Factors | 02575R | LA |
N | 2251N0400X | Physical Therapist - Neurology | 02575R | LA |
N | 2251S0007X | Physical Therapist - Sports | 02575R | LA |
N | 2251X0800X | Physical Therapist - Orthopedic | 02575R | LA |
NPI | 1962767624 |
---|---|
Provider Name | Mr. Randy Joe Rose |
First Address | New Orleans, LA 70124-2745 |
Second Address | New Orleans, LA 70124-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 09/07/2012 |