Provider Demographics
NPI:1063018083
Name:ROSE, VICTORIA (DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ROSE
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 1:13014 NE 101ST PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5274
Mailing Address - Country:US
Mailing Address - Phone:425-443-3063
Mailing Address - Fax:
Practice Address - Street 1:2707 171ST PL NE STE 101
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4740
Practice Address - Country:US
Practice Address - Phone:360-386-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist