Provider Demographics
NPI:1225644578
Name:BARRY, ROZELDA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ROZELDA
Middle Name:ELIZABETH
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 OTSEGO ST APT 339
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-6828
Mailing Address - Country:US
Mailing Address - Phone:407-558-4369
Mailing Address - Fax:
Practice Address - Street 1:11130 OTSEGO ST APT 339
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-6828
Practice Address - Country:US
Practice Address - Phone:407-558-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist