Provider Demographics
NPI:1689955684
Name:ROSA CHIROPRACTIC AND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ROSA CHIROPRACTIC AND PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-363-8964
Mailing Address - Street 1:13902 N DALE MABRY HWY STE 134
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2441
Mailing Address - Country:US
Mailing Address - Phone:813-443-3915
Mailing Address - Fax:813-968-7999
Practice Address - Street 1:13902 N DALE MABRY HWY STE 134
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2441
Practice Address - Country:US
Practice Address - Phone:813-443-3915
Practice Address - Fax:813-968-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty