MEDICARE: DEBRA JANET ROSEBROCK PTA

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	225200000X	Physical Therapy Assistant	06001776A	IN

General Provider Information

NPI Number	:	1437978509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA JANET ROSEBROCK PTA

Provider Business Mailing Address
First Line	:	4000 STATE ROAD 45
Second Line	:
City	:	NASHVILLE
State	:	IN
Zip	:	47448-8246
Country	:	US
Telephone Number	:	317-796-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 WILLOW ST
Second Line	:
City	:	NASHVILLE
State	:	IN
Zip	:	47448-7604
Country	:	US
Telephone Number	:	812-988-3909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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