Provider Demographics
NPI:1407101769
Name:ROSE, KASSI KAY (DPT)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:KAY
Last Name:ROSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 GRAY FOX RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8422
Mailing Address - Country:US
Mailing Address - Phone:704-821-0568
Mailing Address - Fax:704-821-0570
Practice Address - Street 1:2814 GRAY FOX RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8422
Practice Address - Country:US
Practice Address - Phone:704-821-0568
Practice Address - Fax:704-821-0570
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist