Provider Demographics
NPI:1295216406
Name:MASI, ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MASI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 INGALSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12083-2040
Mailing Address - Country:US
Mailing Address - Phone:518-965-2390
Mailing Address - Fax:
Practice Address - Street 1:11145 ROUTE 32
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12083
Practice Address - Country:US
Practice Address - Phone:518-966-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043266-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist