Provider Demographics
NPI:1003144668
Name:ROSA, MAUREEN B (DPT)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:B
Last Name:ROSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:BALDAUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1503
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:408-238-1552
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:408-389-3600
Practice Address - Fax:408-389-3600
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR790YMedicare PIN