Individual
AMANDA DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCEP, DPT
Contact information
Practice address
3506 WASHINGTON RD, KENOSHA, WI 53144-1654
(262) 653-3800
Mailing address
5802 40TH AVE, KENOSHA, WI 53144-2746
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12399-024
WI
Other
Enumeration date
06/04/2013
Last updated
06/04/2013
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