Provider Demographics
NPI:1811746647
Name:ARAUJO, KELLY ROSAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSAS
Last Name:ARAUJO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24582 CHRISANTA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4811
Mailing Address - Country:US
Mailing Address - Phone:949-735-3802
Mailing Address - Fax:
Practice Address - Street 1:100 OCEANGATE STE P245
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4349
Practice Address - Country:US
Practice Address - Phone:562-432-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic