MEDICARE: DAWN NICHELLE ROSADO MPT

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	225100000X	Physical Therapist	PT19721	FL

General Provider Information

NPI Number	:	1578568952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN NICHELLE ROSADO MPT

Provider Business Mailing Address
First Line	:	3599 UNIVERSITY BLVD. SOUTH
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-854-2090
Fax Number	:	904-854-2093

Provider Business Practice Location Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	904-854-2090
Fax Number	:	904-854-2093

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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