Provider Demographics
NPI:1669109542
Name:ROSIE, CARA L (PTA)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:ROSIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 GLENN MITCHELL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-507-0015
Mailing Address - Fax:757-301-7486
Practice Address - Street 1:1975 GLENN MITCHELL DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-507-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605692225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant