Provider Demographics
NPI:1750120432
Name:ROSASCO, HEIDI S (PT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:ROSASCO
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 1:2211 S HIGHWAY 77 STE 200
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4641
Mailing Address - Country:US
Mailing Address - Phone:850-252-1414
Mailing Address - Fax:850-388-4555
Practice Address - Street 1:528 B CECIL COSTIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-252-1414
Practice Address - Fax:850-388-4555
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty