Basic Information
Provider Information
NPI: 1710003108
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILANA
FirstName: ROSE
MiddleName: PUEBLOS
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 720 COOL SPRINGS BLVD
Address2: SUITE 300
City: FRANKLIN
State: TN
PostalCode: 370672626
CountryCode: US
TelephoneNumber: 6157784066
FaxNumber: 6157789114
Practice Location
Address1: 740 NORDAHL RD
Address2: #117
City: SAN MARCOS
State: CA
PostalCode: 920693543
CountryCode: US
TelephoneNumber: 6157784066
FaxNumber: 6157789114
Other Information
ProviderEnumerationDate: 03/21/2007
LastUpdateDate: 05/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 29684CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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