Healthcare Provider Details

I. General information

NPI: 1043869993
Provider Name (Legal Business Name): SCHUYLER ROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MEDCALF STREET
MONTESANO WA
98563
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5717
US

V. Phone/Fax

Practice location:
  • Phone: 360-249-2273
  • Fax:
Mailing address:
  • Phone: 800-995-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP160985520
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: