Healthcare Provider Details

I. General information

NPI: 1124957386
Provider Name (Legal Business Name): LAWRENCE MICHAEL ROSALES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 DENNERY RD STE 301
SAN DIEGO CA
92154-8455
US

IV. Provider business mailing address

4223 ARIZONA ST APT 8
SAN DIEGO CA
92104-6106
US

V. Phone/Fax

Practice location:
  • Phone: 619-859-4501
  • Fax:
Mailing address:
  • Phone: 707-392-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: