Provider Demographics
NPI:1518009174
Name:ROSA, MONICA I (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:I
Last Name:ROSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:I
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3615 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3368
Mailing Address - Country:US
Mailing Address - Phone:786-863-2324
Mailing Address - Fax:855-859-0123
Practice Address - Street 1:3615 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3368
Practice Address - Country:US
Practice Address - Phone:502-909-0772
Practice Address - Fax:855-859-0123
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008540225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist