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NPI Code Detail

MEDICARE: JUSTIN DANIEL ROSAS

MEDICARE: JUSTIN DANIEL ROSAS
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
1225200000XPhysical Therapy Assistant2168919TX

General Provider Information

NPI Number : 1649917311
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN DANIEL ROSAS
Provider Business Mailing Address
First Line : 14302 NEMO CT
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78418-6238
Country : US
Telephone Number : 361-949-9898
Fax Number : 361-949-9897
Provider Business Practice Location Address
First Line : 14302 NEMO CT
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78418-6238
Country : US
Telephone Number : 361-949-9898
Fax Number : 361-949-9897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2022
Last Update Date : 05/16/2022

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