Amber D Da Gama Rose, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070012212 Issued in IL

Practice address

35 Executive Plaza CT
Maryville, IL 62062-5838

Phone

(618) 226-8277

NPI assigned

Nov 3, 2008

Last updated

Apr 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amber D Taylor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Moxie Pelvic Health and Wellness, PLLC

  • Physical Therapy Clinic/Center
  • Maryville, IL
  • NPI 1497539779
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1972756922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 EXECUTIVE PLAZA CT",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625838",
            "telephone_number": "618-226-8277",
            "fax_number": "618-228-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 EXECUTIVE PLAZA CT",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625838",
            "telephone_number": "618-226-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DA GAMA ROSE",
        "first_name": "AMBER",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-03",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070012212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "TAYLOR",
            "middle_name": "D",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cornerstone Counseling, P.C.
• Counselors Associates
• Jasmine Cowan, DNP, APRN, PMHNP-BC
• Abigail Jacqueline Crabtree, PA
• Jennifer Cullen
• James Joseph Dalla Riva, M.D.
• Federico Morta David
• Kimberly M. David, OTR
• Sarah Raenel 'Nel' Daymon, MS, CCC-SLP
• Arianne Elizabeth Dehr, PA-C

• Physical Therapist in Maryville, IL
• Providers in Maryville, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.

Verify at the official NPI Registry.