Individual
JARED ANDREW ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
121 N WASHINGTON, AFTON, WY 83110
(307) 885-4278
(307) 885-4270
Mailing address
1551 RENAISSANCE TOWNE DR STE 350, BOUNTIFUL, UT 84010-7674
(801) 295-3553
(801) 295-3599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3957
NV
225100000X
Physical Therapist
Primary
PT-2055
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-2055
WYOMING PHYSICAL THERAPY LICENSE
WY
Enumeration date
02/11/2019
Last updated
06/10/2021
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