Provider Demographics
NPI:1245385509
Name:ROSAS, DON K (PT)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:K
Last Name:ROSAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90733-0349
Mailing Address - Country:US
Mailing Address - Phone:310-548-0101
Mailing Address - Fax:310-548-0559
Practice Address - Street 1:28924 S WESTERN AVE
Practice Address - Street 2:STE 101
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0885
Practice Address - Country:US
Practice Address - Phone:310-548-0104
Practice Address - Fax:310-548-0559
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33311OtherPT LICENSE
CAW14553OtherMEDICARE GROUP
CAWPT33311AMedicare PIN