Provider Demographics
NPI:1881137040
Name:ROSE, RITU
Entity type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 QUEENS CHAPEL RD APT 608
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3633
Mailing Address - Country:US
Mailing Address - Phone:480-428-9650
Mailing Address - Fax:
Practice Address - Street 1:1330 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4155
Practice Address - Country:US
Practice Address - Phone:206-274-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25974225100000X
DCPT872446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD437404500Medicaid
MD1447657507OtherNPI TYPE 2/ ORGANISATION
337361,337362Medicare PIN