Provider Demographics
NPI:1922219112
Name:HINES, ROSE ANNA (MS, PT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANNA
Last Name:HINES
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11533 AEOLIAN ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3303
Mailing Address - Country:US
Mailing Address - Phone:562-695-3552
Mailing Address - Fax:
Practice Address - Street 1:11533 AEOLIAN ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3303
Practice Address - Country:US
Practice Address - Phone:562-695-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT007936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist