Provider Demographics
NPI:1649946401
Name:ROSELLI, JOHN JOSEPH JR (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:ROSELLI
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:JOSEPH
Other - Last Name:ROSELLI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:601 PATTON BLVD APT 406
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8975
Mailing Address - Country:US
Mailing Address - Phone:516-512-4887
Mailing Address - Fax:
Practice Address - Street 1:4430 LAVON DR STE 340
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2974
Practice Address - Country:US
Practice Address - Phone:972-495-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1352417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist