Healthcare Provider Details

I. General information

NPI: 1629047493
Provider Name (Legal Business Name): ROSE SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SCIOTO ST
CINCINNATI OH
45219-2072
US

IV. Provider business mailing address

5911 MORGAN RD
CLEVES OH
45002-9428
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-3178
  • Fax:
Mailing address:
  • Phone: 513-353-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1755
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: