Provider Demographics
NPI:1902393416
Name:ROSSETTI, ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ROSSETTI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-3208
Mailing Address - Country:US
Mailing Address - Phone:828-200-7248
Mailing Address - Fax:
Practice Address - Street 1:4650 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8404
Practice Address - Country:US
Practice Address - Phone:828-200-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6323225100000X
NCP17330225100000X
SC8747225100000X
VA2305211393225100000X
CA294299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist