Provider Demographics
NPI:1215385356
Name:ROSE, MARGARET MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:ROSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:TORRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9041 ELLIS LN
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-3938
Mailing Address - Country:US
Mailing Address - Phone:540-270-9461
Mailing Address - Fax:
Practice Address - Street 1:9041 ELLIS LN
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-3938
Practice Address - Country:US
Practice Address - Phone:540-270-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist