Provider Demographics
NPI:1508098278
Name:DE LA ROSA, RAYSA P (PTA)
Entity Type:Individual
Prefix:
First Name:RAYSA
Middle Name:P
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:RAYSA
Other - Middle Name:P
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2535 HUNLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-5807
Mailing Address - Country:US
Mailing Address - Phone:813-394-9403
Mailing Address - Fax:
Practice Address - Street 1:2535 HUNLEY LOOP
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-5807
Practice Address - Country:US
Practice Address - Phone:813-394-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21677225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant