Basic Information
Provider Information | |||||||||
NPI: | 1932589454 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROXAS | ||||||||
FirstName: | ROSELYN | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROXAS | ||||||||
OtherFirstName: | ROSELYN | ||||||||
OtherMiddleName: | ARROJADO | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 113 ROUTE 73 | ||||||||
Address2: | VOORHEES | ||||||||
City: | VOORHEES | ||||||||
State: | NJ | ||||||||
PostalCode: | 080439573 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8568093559 | ||||||||
FaxNumber: | 8568093573 | ||||||||
Practice Location | |||||||||
Address1: | 2601 E EVESHAM RD | ||||||||
Address2: |   | ||||||||
City: | VOORHEES | ||||||||
State: | NJ | ||||||||
PostalCode: | 080439509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8564824451 | ||||||||
FaxNumber: | 8569858365 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2015 | ||||||||
LastUpdateDate: | 06/12/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00500100 | NJ | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | R6904 67161 55622 | 01 | NJ | NJ DRIVER'S LICENSE NO. | OTHER |