Healthcare Provider Details

I. General information

NPI: 1376767970
Provider Name (Legal Business Name): MARY ROSEN PT ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE PHYSICAL THERAPY
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE PHYSICAL THERAPY
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7216
  • Fax:
Mailing address:
  • Phone: 617-355-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number07568
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: