MEDICARE: MR. BRIAN J ROSE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	114203	MO

General Provider Information

NPI Number	:	1023029113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN J ROSE PT

Provider Business Mailing Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	SUITE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-416-0439
Fax Number	:	314-416-7626

Provider Business Practice Location Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	SUITE 120
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-416-1707
Fax Number	:	314-416-7184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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