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
StateLicense IDTaxonomies
CA29371225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-0-0OtherN/A