Provider Demographics
NPI:1376856526
Name:ROSE, TERRENCE MICHAEL JR (DPT)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:MICHAEL
Last Name:ROSE
Suffix:JR
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 1:180 PARK CLUB LN STE 225A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5260
Mailing Address - Country:US
Mailing Address - Phone:716-479-8752
Mailing Address - Fax:716-670-6070
Practice Address - Street 1:180 PARK CLUB LN STE 225A
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5260
Practice Address - Country:US
Practice Address - Phone:716-479-8752
Practice Address - Fax:716-674-6070
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010381-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist