Provider Demographics
NPI:1740835412
Name:ROSAL, RYKA KRISTEL (PT)
Entity type:Individual
Prefix:
First Name:RYKA
Middle Name:KRISTEL
Last Name:ROSAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NEIL CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5815
Mailing Address - Country:US
Mailing Address - Phone:516-766-0505
Mailing Address - Fax:516-766-0680
Practice Address - Street 1:309 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3241
Practice Address - Country:US
Practice Address - Phone:516-568-7858
Practice Address - Fax:516-568-7860
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA041587-1208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist