Provider Demographics
NPI:1568409498
Name:MARK J. ROSEN, R.P.T., P.C.
Entity Type:Organization
Organization Name:MARK J. ROSEN, R.P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-677-8870
Mailing Address - Street 1:12000 BUSTLETON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2151
Mailing Address - Country:US
Mailing Address - Phone:215-677-8870
Mailing Address - Fax:215-673-9825
Practice Address - Street 1:12000 BUSTLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2151
Practice Address - Country:US
Practice Address - Phone:215-677-8870
Practice Address - Fax:215-673-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2218555000OtherPERSONAL CHOICE/KEYSTONE
PA091386Medicare ID - Type UnspecifiedMEDICARE GROUP