Provider Demographics
NPI:1326115056
Name:ROSA, IRMA J (PT, C/NDT)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:J
Last Name:ROSA
Suffix:
Gender:F
Credentials:PT, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6125
Mailing Address - Country:US
Mailing Address - Phone:407-852-3316
Mailing Address - Fax:407-852-3301
Practice Address - Street 1:3305 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6125
Practice Address - Country:US
Practice Address - Phone:407-852-3316
Practice Address - Fax:407-852-3301
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880022700Medicaid