Provider Demographics
NPI:1073574133
Name:DELONG, ROSA LEE (DPT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:LEE
Last Name:DELONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:LEE
Other - Last Name:HENSLEY
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2135 ARGILLITE RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1629
Mailing Address - Country:US
Mailing Address - Phone:606-388-2470
Mailing Address - Fax:
Practice Address - Street 1:2135 ARGILLITE RD
Practice Address - Street 2:SUITE K
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1629
Practice Address - Country:US
Practice Address - Phone:606-388-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011414225100000X
WV002560225100000X
KY005050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2663256Medicaid
KY7100010080Medicaid
WV3810008114Medicaid
WV4181892Medicare PIN
WV3810008114Medicaid
OH2663256Medicaid
OHP00309181Medicare PIN
KY7100010080Medicaid