Provider Demographics
NPI:1013045178
Name:ROOSA, ERIN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ROOSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 180
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4502
Mailing Address - Country:US
Mailing Address - Phone:301-620-7478
Mailing Address - Fax:
Practice Address - Street 1:141 THOMAS JOHNSON DR
Practice Address - Street 2:STE 180
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4502
Practice Address - Country:US
Practice Address - Phone:301-620-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160584OtherUNITED HEALTHCARE
T208OtherCAREFIRST/GHMSI
2160584OtherACN
647726-03OtherBCBS OF MARYLAND
7914198OtherAETNA
969LP569Medicare PIN
CJ2189Medicare PIN