Provider Demographics
NPI:1346676350
Name:DEAKERS, ROSE A (PT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:DEAKERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:2901 PARK AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-706-2085
Practice Address - Fax:831-417-3799
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist