Provider Demographics
NPI:1477572592
Name:ROSENBERG, RICHARD M A (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M A
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8068 MESA OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0646
Mailing Address - Country:US
Mailing Address - Phone:916-726-3481
Mailing Address - Fax:916-726-3481
Practice Address - Street 1:1635 CREEKSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3830
Practice Address - Country:US
Practice Address - Phone:916-983-5611
Practice Address - Fax:916-983-5615
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT263570Medicare ID - Type UnspecifiedPART B CARRIER
CAP00284487Medicare ID - Type UnspecifiedRAILROAD CARRIER PART B