Provider Demographics
NPI:1922680107
Name:ROSAL, JONART RABONZA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JONART
Middle Name:RABONZA
Last Name:ROSAL
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 1:627 GARIS AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3103
Mailing Address - Country:US
Mailing Address - Phone:760-977-1554
Mailing Address - Fax:760-463-1104
Practice Address - Street 1:627 GARIS AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3103
Practice Address - Country:US
Practice Address - Phone:760-977-1554
Practice Address - Fax:760-463-1104
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist