Healthcare Provider Details

I. General information

NPI: 1558905851
Provider Name (Legal Business Name): ROSE RAPP LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 JESSE ROBBINS RD STE E
BELFAST ME
04915-7510
US

IV. Provider business mailing address

8 JESSE ROBBINS RD STE E
BELFAST ME
04915-7510
US

V. Phone/Fax

Practice location:
  • Phone: 207-322-8368
  • Fax:
Mailing address:
  • Phone: 207-322-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1541
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMT1541
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: