Provider Demographics
NPI:1578259941
Name:ROSEN, CARLY LAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:LAYNE
Last Name:ROSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 GLEN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1225
Mailing Address - Country:US
Mailing Address - Phone:248-752-4396
Mailing Address - Fax:
Practice Address - Street 1:3870 GLEN FALLS DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48302-1225
Practice Address - Country:US
Practice Address - Phone:248-752-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64948225100000X
MI5501302367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist