Provider Demographics
NPI:1700050465
Name:ROSETTE, AMANDA JESSICA (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JESSICA
Last Name:ROSETTE
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 1:6707 SPRINGPARK AVE
Mailing Address - Street 2:#6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-2364
Mailing Address - Country:US
Mailing Address - Phone:310-872-0977
Mailing Address - Fax:
Practice Address - Street 1:6707 SPRINGPARK AVE
Practice Address - Street 2:#6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-2364
Practice Address - Country:US
Practice Address - Phone:310-872-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist