Active NPI
Melissa R Rose, PT, DPT, OCS
- Physical Therapist
- El Segundo, CA
National Provider Identifier
1558488148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1173293
- Practice address
- 483 N Aviation Blvd
El Segundo, CA 90245-2808 - Phone
- (310) 653-5868
- NPI assigned
- Mar 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 1173293 | TX | |
| Physical Therapist | 225100000X | 011516 | OH | |
| Physical Therapist | 225100000X | 1173293 | TX | Primary |
Addresses
Primary practice location
483 N Aviation Blvd
El Segundo, CA 90245-2808
Mailing address
483 N Aviation Blvd
El Segundo, CA 90245-2808
Phone (310) 653-5868
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1173293 | TX | MD | Military Health Care Provider |
| 011516 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709856000000",
"number": "1558488148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-5868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-5868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "MELISSA",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PT, DPT, OCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2024-03-08",
"certification_date": "2024-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "TX",
"license": "1173293",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "011516",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1173293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.