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General NPI Number Information
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NPI Number | 1922283696
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Entity Type | Individual
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Provider Name | STACEY K ROSELLON MSPT
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Gender | Female
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 111 W OLD COUNTRY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-4036
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Country | US
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Telephone | 516-433-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 311 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-1502
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Country | US
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Telephone |
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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 | 6188716
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License Number State | NY
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