Healthcare Provider Details

I. General information

NPI: 1013008564
Provider Name (Legal Business Name): KRISTI M ROSA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 BRANDYWINE PKWY
WEST CHESTER PA
19380-4278
US

IV. Provider business mailing address

638 BRANDYWINE PKWY
WEST CHESTER PA
19380-4278
US

V. Phone/Fax

Practice location:
  • Phone: 610-436-3600
  • Fax: 610-436-3604
Mailing address:
  • Phone: 610-436-3600
  • Fax: 610-436-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT21002
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT019824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: