Provider Demographics
NPI:1760174171
Name:ROSE, JANINE (CMT, PTA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:CMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 S BURKE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-5513
Mailing Address - Country:US
Mailing Address - Phone:707-744-1770
Mailing Address - Fax:
Practice Address - Street 1:3440 W FLAGSTAFF AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7174
Practice Address - Country:US
Practice Address - Phone:707-744-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49674225200000X
CA67488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant