MEDICARE: JOHNNY PHILLIP ROSIER

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	106H00000X	Marriage & Family Therapist	1076	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62-56832	OTHER	MN	UBH PIN NUMBER

General Provider Information

NPI Number	:	1982754891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY PHILLIP ROSIER

Provider Business Mailing Address
First Line	:	310 E 38TH ST
Second Line	:	SUITE 320
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 E 38TH ST
Second Line	:	SUITE 320
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-243-1600
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/24/2007

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