Provider Demographics
NPI:1669504643
Name:OSTENDORF, ROSELLE GARCIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROSELLE
Middle Name:GARCIA
Last Name:OSTENDORF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10168 MENAUL BLVD NE
Mailing Address - Street 2:S8
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2386
Mailing Address - Country:US
Mailing Address - Phone:505-850-9665
Mailing Address - Fax:
Practice Address - Street 1:3301 COORS BLVD NW
Practice Address - Street 2:SUITE K-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1229
Practice Address - Country:US
Practice Address - Phone:505-843-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist