Provider Demographics
NPI:1083826739
Name:EXANTUS, ROSHONDA (MS, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:ROSHONDA
Middle Name:
Last Name:EXANTUS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18310 NW 21 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2701
Mailing Address - Country:US
Mailing Address - Phone:786-395-0120
Mailing Address - Fax:
Practice Address - Street 1:FLORIDA A&M UNIVERSITY
Practice Address - Street 2:1835 WAHNISH WAY
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-599-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL17532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer