Provider Demographics
NPI:1023563954
Name:LA ROSA, JASON ANTHONY MARTINS (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANTHONY MARTINS
Last Name:LA ROSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:914 BARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1102
Mailing Address - Country:US
Mailing Address - Phone:408-687-5041
Mailing Address - Fax:
Practice Address - Street 1:2944 BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1510
Practice Address - Country:US
Practice Address - Phone:650-261-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2918952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic