Provider Demographics
NPI:1417644634
Name:MICHAEL ROSE PT INC
Entity Type:Organization
Organization Name:MICHAEL ROSE PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-278-0063
Mailing Address - Street 1:2030 S OCEAN DR APT 426
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6658
Mailing Address - Country:US
Mailing Address - Phone:215-278-0063
Mailing Address - Fax:954-719-5664
Practice Address - Street 1:2030 S OCEAN DR APT 426
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6658
Practice Address - Country:US
Practice Address - Phone:215-278-0063
Practice Address - Fax:954-719-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty