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General NPI Number Information
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NPI Number | 1508550955
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Entity Type | Individual
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Provider Name | MARK MANUEL ROSALES DPT
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Gender | Male
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1445 GALAXY DR NE STE 301
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City | LACEY
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State | WA
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Zip | 98516-4754
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Country | US
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Telephone | 360-456-1444
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Fax | 360-456-1883
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Provider Business Mailing Address
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Address Line | 7422 20TH AVE SE
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City | LACEY
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State | WA
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Zip | 98503-3007
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Country | US
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Telephone | 253-740-1902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61444475
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License Number State | WA
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