Provider Demographics
NPI:1760542989
Name:UTT, DELLA ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DELLA
Middle Name:ROSE
Last Name:UTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DELLA
Other - Middle Name:ROSE
Other - Last Name:GRABOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:27172 HWY. 189
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0784
Mailing Address - Country:US
Mailing Address - Phone:909-337-4192
Mailing Address - Fax:909-336-1982
Practice Address - Street 1:26571 HIGHWAY 18
Practice Address - Street 2:SUITE B
Practice Address - City:RIMFOREST
Practice Address - State:CA
Practice Address - Zip Code:92378-0010
Practice Address - Country:US
Practice Address - Phone:909-337-4192
Practice Address - Fax:909-336-1982
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14007225100000X
CAPT14007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist