Provider Demographics
NPI:1700909355
Name:DE LA ROSA, DANIEL ANAHUAC (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANAHUAC
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E LINDA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3508
Mailing Address - Country:US
Mailing Address - Phone:626-919-0124
Mailing Address - Fax:626-919-0124
Practice Address - Street 1:210 WEST COLLEGE STREET
Practice Address - Street 2:CARTER PHYSICAL THERAPY
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-967-7833
Practice Address - Fax:626-859-2633
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist