Healthcare Provider Details

I. General information

NPI: 1215664578
Provider Name (Legal Business Name): ARIANNE DAPHNE ALLADO ROSCA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 SW RAMSEY AVE
GRANTS PASS OR
97527-5681
US

IV. Provider business mailing address

1580 CORPORATE PARKWAY, SUITE 200
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11704
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: