Provider Demographics
NPI:1770976011
Name:WAN ZAID, ROSEALIZA (DPT)
Entity type:Individual
Prefix:
First Name:ROSEALIZA
Middle Name:
Last Name:WAN ZAID
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PLEASANT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2533
Mailing Address - Country:US
Mailing Address - Phone:508-640-5000
Mailing Address - Fax:
Practice Address - Street 1:425 PLEASANT ST STE 202
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2533
Practice Address - Country:US
Practice Address - Phone:508-640-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2025-02-20
Deactivation Date:2025-02-11
Deactivation Code:
Reactivation Date:2025-02-20
Provider Licenses
StateLicense IDTaxonomies
MA21562208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation