Provider Demographics
NPI:1457497158
Name:DEL ROSARIO, THERESA L (CMT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:L
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 OTTO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4130
Mailing Address - Country:US
Mailing Address - Phone:612-327-0183
Mailing Address - Fax:
Practice Address - Street 1:557 7TH ST W
Practice Address - Street 2:SUITE 6
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3065
Practice Address - Country:US
Practice Address - Phone:612-327-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist