Provider Demographics
NPI:1689048100
Name:KOERBER, ROSEANN (DPT)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:KOERBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROSEANN
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:805-540-4359
Mailing Address - Fax:805-200-3769
Practice Address - Street 1:1414 PARK ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2160
Practice Address - Country:US
Practice Address - Phone:805-226-0975
Practice Address - Fax:805-226-0909
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist