Organization
IN HOME PEDIATRIC PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE DUES P.T. (ROSE DUES, PT)
(502) 510-5297
Entity
Organization
Contact information
Practice address
2468 DYSART RD, UNIVERSITY HEIGHTS, OH 44118-4445
(502) 510-5297
(801) 681-0724
Mailing address
2468 DYSART RD, UNIVERSITY HEIGHTS, OH 44118-4445
(502) 510-5297
(801) 681-0724
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
012483
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012483
OHIO PHYSICAL THERAPY LICENSE
OH
01
—
42253
APTA BOARD CERTIFIED CLINICAL SPECIALIST PEDIATRICS
OH
01
—
OH3206763
STATE OF OHIO DEPARTMENT OF EDUCATION PROFESSIONAL PUPIL LICENSE
OH
Enumeration date
09/05/2014
Last updated
09/05/2014
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