Provider Demographics
NPI: | 1639180540 |
---|---|
Name: | ROOS, KAREN (PHD, MSPT, ATC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KAREN |
Middle Name: | |
Last Name: | ROOS |
Suffix: | |
Gender: | F |
Credentials: | PHD, MSPT, ATC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1250 BELLFLOWER BLVD |
Mailing Address - Street 2: | HHS2-205 |
Mailing Address - City: | LONG BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90840 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1250 BELLFLOWER BLVD |
Practice Address - Street 2: | HHS2-205 |
Practice Address - City: | LONG BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90840 |
Practice Address - Country: | US |
Practice Address - Phone: | 949-307-6101 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-10 |
Last Update Date: | 2021-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 29371 | 225100000X |
2255A2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
0-0-0 | Other | N/A |