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NPI Code Detail

MEDICARE: DYLAN ROBERT ROSE PT

MEDICARE: DYLAN ROBERT ROSE PT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1285270314
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN ROBERT ROSE PT
Provider Business Mailing Address
First Line : PO BOX 5545
Second Line :
City : AUGUSTA
State : GA
Zip : 30916-5545
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2498 WASHINGTON RD STE A
Second Line :
City : THOMSON
State : GA
Zip : 30824-6600
Country : US
Telephone Number : 706-391-6232
Fax Number : 706-842-6751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2019
Last Update Date : 11/25/2019

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