Provider Demographics
NPI:1578519013
Name:MARCANTONIO, ROSALIE JO (PT)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:JO
Last Name:MARCANTONIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:JO
Other - Last Name:VILLARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:8107 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6154
Practice Address - Country:US
Practice Address - Phone:253-584-6555
Practice Address - Fax:253-584-6926
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9605MAOtherREGENCE BLUESHIELD
WA8938322OtherL&I CRIME VICTIMS PROG
WA184344OtherLABOR & INDUSTRIES
WA8390932Medicaid
WA8802553Medicare ID - Type Unspecified
WA8390932Medicaid