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General NPI Number Information
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NPI Number | 1831853001
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Entity Type | Individual
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Provider Name | MICHAEL JAMES ROSENCRUM PTA
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Gender | Male
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 175 BLUEBERRY LN
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City | LACONIA
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State | NH
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Zip | 03246-2918
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Country | US
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Telephone | 603-273-6459
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 135
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City | ASHLAND
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State | NH
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Zip | 03217-0135
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Country | US
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Telephone | 910-545-4430
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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 | 1316
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License Number State | NH
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