Provider Demographics
NPI:1629488655
Name:O'LEARY, ROSANNE
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6759 SIERRA CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2670
Mailing Address - Country:US
Mailing Address - Phone:925-803-0530
Mailing Address - Fax:925-803-2047
Practice Address - Street 1:6759 SIERRA CT
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2670
Practice Address - Country:US
Practice Address - Phone:925-803-0530
Practice Address - Fax:925-803-2047
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist