Individual
ROSA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
396 TOWNSHIP ROAD 506, KITTS HILL, OH 45645-9063
(740) 867-4959
Mailing address
396 TOWNSHIP ROAD 506, KITTS HILL, OH 45645-9063
(740) 867-4959
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
28344
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441014725201
—
OH
Enumeration date
07/11/2016
Last updated
07/11/2016
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