Healthcare Provider Details

I. General information

NPI: 1356703987
Provider Name (Legal Business Name): MR. ARNEL RAFAEL ROSAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY STE 200
SUNRISE FL
33323-2869
US

IV. Provider business mailing address

4919 W LAWRENCE AVE
CHICAGO IL
60630-3843
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-4247
  • Fax:
Mailing address:
  • Phone: 872-203-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003461
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: