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General NPI Number Information
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NPI Number | 1306151550
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Entity Type | Organization
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Legal Business Name | ROSE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 60 LAKESIDE DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-1748
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Country | US
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Telephone | 716-479-8752
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Fax | 716-634-3193
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Provider Business Mailing Address
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Address Line | 60 LAKESIDE DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-1748
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Country | US
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Telephone | 716-479-8752
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Fax | 716-634-3193
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Authorized Official
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Title or Position | OWNER
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Name | TERRENCE M. ROSE
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Credential | DPT
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Telephone | 716-479-8752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 010381
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License Number State | NY
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