Provider Demographics
NPI:1053666784
Name:ROSA, SORELIS (DPT)
Entity Type:Individual
Prefix:
First Name:SORELIS
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:24 SAW MILL RIVER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1541
Mailing Address - Country:US
Mailing Address - Phone:914-631-6969
Mailing Address - Fax:914-631-0943
Practice Address - Street 1:24 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1541
Practice Address - Country:US
Practice Address - Phone:914-631-6969
Practice Address - Fax:914-631-0943
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY035090-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist