Provider Demographics
NPI:1255427662
Name:ROSARIO, DOUGLAS P (PT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5571
Mailing Address - Country:US
Mailing Address - Phone:503-797-9585
Mailing Address - Fax:503-797-0650
Practice Address - Street 1:1 N CENTER COURT ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2104
Practice Address - Country:US
Practice Address - Phone:503-797-9585
Practice Address - Fax:503-797-0650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist