MEDICARE: ROSA CHIROPRACTIC & PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7791	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GA834Z	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1154742633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSA CHIROPRACTIC & PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	13902 N DALE MABRY HWY STE 134
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2441
Country	:	US
Telephone Number	:	813-443-3915
Fax Number	:	813-968-7999

Provider Business Practice Location Address
First Line	:	13902 N DALE MABRY HWY STE 134
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2441
Country	:	US
Telephone Number	:	813-443-3915
Fax Number	:	813-968-7999

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	YVETTE ROSA
Credential	:	D.C
Telephone Number	:	813-363-8964

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	07/21/2022

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