Provider Demographics
NPI:1467090217
Name:ROSE, ELIZABETH ANN (PT,MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:222 WESTCHESTER AVE STE G-02
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-681-2056
Mailing Address - Fax:914-681-2967
Practice Address - Street 1:222 WESTCHESTER AVE STE G-02
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-681-2056
Practice Address - Fax:914-681-2967
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020460-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty