Provider Demographics
NPI:1326309741
Name:ROSSBERG, GINNY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:ROSSBERG
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6301 FOREST HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4137
Mailing Address - Country:US
Mailing Address - Phone:505-823-8345
Mailing Address - Fax:505-823-8355
Practice Address - Street 1:1408 LOMAS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1236
Practice Address - Country:US
Practice Address - Phone:505-264-6752
Practice Address - Fax:949-404-8551
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT2925225X00000X
NM2925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM04728084Medicaid