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General NPI Number Information
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NPI Number | 1760704001
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Entity Type | Individual
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Provider Name | XAVIER ANTIONE ROSEMOND PTA
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Gender | Male
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 379 PINEHAVEN ST. EXT
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City | LAURENS
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State | SC
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Zip | 29360-2671
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Country | US
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Telephone | 864-984-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 HAYWOOD RD 12N
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City | GREENVILLE
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State | SC
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Zip | 29615-2285
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Country | US
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Telephone | 864-255-4379
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2449
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License Number State | SC
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