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General NPI Number Information
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NPI Number | 1871534339
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Entity Type | Individual
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Provider Name | ROSA PANOS PT, AP, DIPL O.M.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 397 PALM COAST PKWY SW UNIT 5
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City | PALM COAST
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State | FL
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Zip | 32137-4777
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Country | US
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Telephone | 386-447-0610
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Fax | 386-447-0670
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Provider Business Mailing Address
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Address Line | 1012 S CENTRAL AVE
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3723
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Country | US
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Telephone | 386-447-0610
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Fax | 386-447-0670
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 22203
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License Number State | FL
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