Healthcare Provider Details

I. General information

NPI: 1144464074
Provider Name (Legal Business Name): ROSEWORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLONY CROSSING WAY SUITE 250
MADISON MS
39110-7778
US

IV. Provider business mailing address

111 COLONY CROSSING WAY SUITE 250
MADISON MS
39110-7778
US

V. Phone/Fax

Practice location:
  • Phone: 601-898-9330
  • Fax: 601-437-3414
Mailing address:
  • Phone: 601-898-9330
  • Fax: 601-437-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number453
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number453
License Number StateMS

VIII. Authorized Official

Name: MS. TAMARA RENEE ROSE
Title or Position: PRESIDENT
Credential: LMT
Phone: 601-898-9330