Healthcare Provider Details

I. General information

NPI: 1720078496
Provider Name (Legal Business Name): RHONDA RAE ROSENCRANZ MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N TRAUTMAN AVE
BROADUS MT
59317-7504
US

IV. Provider business mailing address

17222 HOSPITAL BLVD STE 120
BROOKSVILLE FL
34601-8906
US

V. Phone/Fax

Practice location:
  • Phone: 406-436-2872
  • Fax:
Mailing address:
  • Phone: 352-277-0300
  • Fax: 352-799-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15240
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 21078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: