Provider Demographics
NPI:1689657645
Name:ROSENTHAL, PAUL (PT, PHD, CLT-LANA)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:PT, PHD, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0040
Mailing Address - Country:US
Mailing Address - Phone:541-469-7314
Mailing Address - Fax:541-469-3669
Practice Address - Street 1:580 5TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-469-7314
Practice Address - Fax:541-469-3669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1641225100000X
CA8374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist