Provider Demographics
NPI:1639891500
Name:HUIZENGA, ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:HUIZENGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 WESTLAKE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3866
Mailing Address - Country:US
Mailing Address - Phone:858-755-5200
Mailing Address - Fax:760-783-5100
Practice Address - Street 1:613 WESTLAKE ST STE 130
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3866
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:760-783-5100
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist