Provider Demographics
NPI:1740595602
Name:MICHELLE DELA ROSA PT LLC
Entity Type:Organization
Organization Name:MICHELLE DELA ROSA PT LLC
Other - Org Name:CONNECT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-584-4770
Mailing Address - Street 1:1675 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3825
Mailing Address - Country:US
Mailing Address - Phone:609-584-4770
Mailing Address - Fax:609-584-4880
Practice Address - Street 1:1675 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3825
Practice Address - Country:US
Practice Address - Phone:609-584-4770
Practice Address - Fax:609-584-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00944200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty