Provider Demographics
NPI:1578075578
Name:ROSA, JUAN TOMAS (OT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:TOMAS
Last Name:ROSA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13371 NW 3RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1662
Mailing Address - Country:US
Mailing Address - Phone:786-393-4869
Mailing Address - Fax:
Practice Address - Street 1:13371 NW 3RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1662
Practice Address - Country:US
Practice Address - Phone:786-393-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18640225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics