MEDICARE: MR. CHRISTOPHER J ROSALES MPT, MPH

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	PT21408	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ64164Z	OTHER	CA	BLUESHIELD

General Provider Information

NPI Number	:	1841419223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER J ROSALES MPT, MPH

Provider Business Mailing Address
First Line	:	3033 CLEVELAND AVE
Second Line	:	#205
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2126
Country	:	US
Telephone Number	:	707-542-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 CLEVELAND AVE
Second Line	:	#205
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2126
Country	:	US
Telephone Number	:	707-542-8313
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	10/07/2014

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