Provider Demographics
NPI:1881849909
Name:ROSE, TYSON ERIC (MPT, SCS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:ERIC
Last Name:ROSE
Suffix:
Gender:M
Credentials:MPT, SCS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 HOPE DRIVE, SUTIE1500, DEPARTMENT OF THERAPY SERVICE
Mailing Address - Street 2:MAIL CODE EC130, PENN STATE HEALTH MILTON S. HERSHEY ME
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033
Mailing Address - Country:US
Mailing Address - Phone:717-531-8070
Mailing Address - Fax:717-531-4558
Practice Address - Street 1:30 HOPE DRIVE, SUTIE1500, DEPARTMENT OF THERAPY SERVICE
Practice Address - Street 2:MAIL CODE EC130, PENN STATE HEALTH MILTON S. HERSHEY ME
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-8070
Practice Address - Fax:717-531-4558
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT-11753225100000X
NCAT-15302255A2300X
PAPT016099225100000X
PART0032792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer