Provider Demographics
NPI:1295399624
Name:ROSE, COE ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:COE
Middle Name:ALLEN
Last Name:ROSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 KANELL BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3060
Mailing Address - Country:US
Mailing Address - Phone:573-785-0761
Mailing Address - Fax:573-785-0031
Practice Address - Street 1:3381 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3060
Practice Address - Country:US
Practice Address - Phone:573-785-0761
Practice Address - Fax:573-785-0031
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist