Provider Demographics
NPI:1821302324
Name:ROSE, MICHAEL S (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:ROSE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2433
Mailing Address - Country:US
Mailing Address - Phone:323-839-2983
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE M120
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3714
Practice Address - Country:US
Practice Address - Phone:310-246-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic