=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417644634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL ROSE PT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2023
-----------------------------------------------------
Last Update Date | 07/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15455 W DIXIE HWY STE B
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-278-0063
-----------------------------------------------------
Fax | 954-719-5664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6399 NW 47TH CT # 426
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-621-2068
-----------------------------------------------------
Fax | 954-719-5664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING MEMBER
-----------------------------------------------------
Name | ERIC ROSENFIELD
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 954-621-2068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------