Provider Demographics
NPI:1639375686
Name:ROSEBRIDGE REHAB
Entity Type:Organization
Organization Name:ROSEBRIDGE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PONTERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-875-5020
Mailing Address - Street 1:1062 SAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1155
Mailing Address - Country:US
Mailing Address - Phone:724-875-5020
Mailing Address - Fax:
Practice Address - Street 1:1062 SAYBROOK DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1155
Practice Address - Country:US
Practice Address - Phone:724-875-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAOC-002318-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty