Provider Demographics
NPI:1093903734
Name:ROSA REHAB,L.L.C.
Entity Type:Organization
Organization Name:ROSA REHAB,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OR CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-316-2111
Mailing Address - Street 1:4037 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1643
Mailing Address - Country:US
Mailing Address - Phone:301-316-2111
Mailing Address - Fax:301-316-5382
Practice Address - Street 1:4037 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1643
Practice Address - Country:US
Practice Address - Phone:301-316-2111
Practice Address - Fax:301-316-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty