MEDICARE: MARISOL ROSA

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	225700000X	Massage Therapist	MSG010231	PA

General Provider Information

NPI Number	:	1518446863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL ROSA

Provider Business Mailing Address
First Line	:	1440 N 2ND ST STE A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3802
Country	:	US
Telephone Number	:	267-266-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N 2ND ST STE A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3802
Country	:	US
Telephone Number	:	267-266-0569
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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Directions to “ MARISOL ROSA ” Practice Location

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