Provider Demographics
NPI:1497953251
Name:ROSE, JAMES DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:ROSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:DAVID
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5779 THETA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4611
Mailing Address - Country:US
Mailing Address - Phone:858-653-6180
Mailing Address - Fax:
Practice Address - Street 1:10243 GENETIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-6310
Practice Address - Country:US
Practice Address - Phone:858-526-6180
Practice Address - Fax:858-526-6052
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 119972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic