Mikko Chiong Dela Rosa

Key facts

NPI

1780169011

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

14337 (WI)

Practice address

1020 Hill St
Watertown, WI 53098-3016

Phone

(920) 206-4935

NPI assigned

Oct 2, 2018

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2018.

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1780169011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 PALMER DR APT 12",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535462316",
            "telephone_number": "773-630-5882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 HILL ST",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983016",
            "telephone_number": "920-206-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELA ROSA",
        "first_name": "MIKKO",
        "middle_name": "CHIONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Watertown, WI · Physical Therapist in Wisconsin