Provider Demographics
NPI:1295928083
Name:BAGASOL, ROZALYN (DPT)
Entity type:Individual
Prefix:
First Name:ROZALYN
Middle Name:
Last Name:BAGASOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROZALYN
Other - Middle Name:
Other - Last Name:PELAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1546
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:408-238-1552
Practice Address - Street 1:121 BERNAL RD STE 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1396
Practice Address - Country:US
Practice Address - Phone:408-227-2141
Practice Address - Fax:408-227-2141
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist