MEDICARE: ROSE SMITH 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
1	225100000X	Physical Therapist	1755	OH

General Provider Information

NPI Number	:	1629047493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE SMITH PT

Provider Business Mailing Address
First Line	:	5911 MORGAN RD
Second Line	:
City	:	CLEVES
State	:	OH
Zip	:	45002-9428
Country	:	US
Telephone Number	:	513-353-2639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 SCIOTO ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2072
Country	:	US
Telephone Number	:	513-556-3178
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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Directions to “ ROSE SMITH PT” Practice Location

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