Healthcare Provider Details

I. General information

NPI: 1063018083
Provider Name (Legal Business Name): VICTORIA ROSE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 171ST PL NE STE 101
MARYSVILLE WA
98271-4740
US

IV. Provider business mailing address

13014 NE 101ST PL
KIRKLAND WA
98033-5274
US

V. Phone/Fax

Practice location:
  • Phone: 360-386-7401
  • Fax:
Mailing address:
  • Phone: 425-443-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: