Healthcare Provider Details

I. General information

NPI: 1467090217
Provider Name (Legal Business Name): ELIZABETH ANN ROSE PT,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH ANN ROSE

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WESTCHESTER AVE STE G-02
WEST HARRISON NY
10604-2906
US

IV. Provider business mailing address

222 WESTCHESTER AVE STE G-02
WEST HARRISON NY
10604-2906
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-2056
  • Fax: 914-681-2967
Mailing address:
  • Phone: 914-681-2056
  • Fax: 914-681-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number020460-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: