Provider Demographics
NPI:1679801237
Name:ROSA, CARLOS (DPT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ROSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1546
Mailing Address - Country:US
Mailing Address - Phone:408-238-1550
Mailing Address - Fax:408-531-1374
Practice Address - Street 1:4055 EVERGREEN VILLAGE SQ
Practice Address - Street 2:STE 260
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1748
Practice Address - Country:US
Practice Address - Phone:408-238-1552
Practice Address - Fax:408-531-1374
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist