Provider Demographics
NPI:1932403359
Name:ROSEBOROUGH, KATHERINE G (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:ROSEBOROUGH
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 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:204 GUMWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6087
Practice Address - Country:US
Practice Address - Phone:757-357-7762
Practice Address - Fax:757-357-7765
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932403359Medicaid
VA9340647OtherAETNA
VA298498OtherBCBS (PHYSICAL THERAPY)
VA298498OtherBCBS (PHYSICAL THERAPY)
VA1932403359Medicaid