Provider Demographics
NPI:1457944498
Name:ROSSI, REGINE S (PT, DPT, PHD, CSCS)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:S
Last Name:ROSSI
Suffix:
Gender:F
Credentials:PT, DPT, PHD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 SAN LUIS CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3326
Mailing Address - Country:US
Mailing Address - Phone:561-602-9552
Mailing Address - Fax:
Practice Address - Street 1:9852 BUSINESS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1709
Practice Address - Country:US
Practice Address - Phone:916-362-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300109225100000X
CT14.012971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist