Provider Demographics
NPI:1164583258
Name:ROSE, ROBYN JENNIFER (MPT, CST-D)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:JENNIFER
Last Name:ROSE
Suffix:
Gender:F
Credentials:MPT, CST-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 LAKE MARION DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4405
Mailing Address - Country:US
Mailing Address - Phone:407-718-7728
Mailing Address - Fax:407-774-1634
Practice Address - Street 1:2933 W STATE ROAD 434 STE 111
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4457
Practice Address - Country:US
Practice Address - Phone:407-774-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist