Provider Demographics
NPI:1437937190
Name:STINE, ROSEMARY VIRGINIA
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:VIRGINIA
Last Name:STINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3219
Mailing Address - Country:US
Mailing Address - Phone:248-937-0527
Mailing Address - Fax:
Practice Address - Street 1:110 E 22ND ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3219
Practice Address - Country:US
Practice Address - Phone:248-937-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist