Provider Demographics
NPI:1760704001
Name:ROSEMOND, XAVIER ANTIONE (PTA)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:ANTIONE
Last Name:ROSEMOND
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 HAYWOOD RD
Mailing Address - Street 2:12N
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2285
Mailing Address - Country:US
Mailing Address - Phone:864-255-4379
Mailing Address - Fax:
Practice Address - Street 1:379 PINEHAVEN ST. EXT
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2671
Practice Address - Country:US
Practice Address - Phone:864-984-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2449225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant