Basic Information
| Provider Information | |||||||||
| NPI: | 1194103929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | MEAGAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT, PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MAASCH | ||||||||
| OtherFirstName: | MEAGAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1769 PEPPERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920211136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194216083 | ||||||||
| FaxNumber: | 6194828284 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 E NAPLES ST # 604 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194216083 | ||||||||
| FaxNumber: | 6194828284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 39610 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.