Edward Rosen, PT
Individual provider Active NPI Physical Therapist · Penngrove, CA
NPI 1689080194 · NPPES record last updated Jul 3, 2014
Key facts
- NPI
- 1689080194
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 7926 (CA)
- Practice address
- 6575 Eagle Ridge Rd
Penngrove, CA 94951-9575 - Phone
- (707) 795-0210
- NPI assigned
- Jul 3, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7926 | CA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7926 | CA | Yes |
Addresses
Primary practice location
6575 Eagle Ridge Rd
Penngrove, CA 94951-9575
Mailing address
6575 Eagle Ridge Rd
Penngrove, CA 94951-9575
Phone (707) 795-0210
Other providers in Penngrove, CA
- Paget Sheldon Mitchell
- Muir Wood LLC
- Muir Wood, LLC.
- Muir Wood, LLC.
- Alexander Edward Perrotti
- Robert Rowen Herzog
- Stephen Smith
- Christina N Wallace
- Kristina Marie Watts
- West Peak Mental Health
All providers in Penngrove, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.