Healthcare Provider Details

I. General information

NPI: 1366920464
Provider Name (Legal Business Name): MEGAN ROSENAU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 NW BURNSIDE RD
GRESHAM OR
97030-3836
US

IV. Provider business mailing address

270 NW BURNSIDE RD
GRESHAM OR
97030-3836
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9147
  • Fax: 503-215-9149
Mailing address:
  • Phone: 503-215-9147
  • Fax: 503-215-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5959
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: