Basic Information
| Provider Information | |||||||||
| NPI: | 1457450561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 DANIEL DR | ||||||||
| Address2: | |||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077302033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089024892 | ||||||||
| FaxNumber: | 9733767101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BETHANY RD | ||||||||
| Address2: | BUILDING 2, SUITE 27 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327395545 | ||||||||
| FaxNumber: | 7327395547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00929900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.