Provider Demographics
NPI:1902537756
Name:ROSALES, ALFREDO JR (MT0024111)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:ROSALES
Suffix:JR
Gender:M
Credentials:MT0024111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-3522
Mailing Address - Country:US
Mailing Address - Phone:970-417-6364
Mailing Address - Fax:
Practice Address - Street 1:525 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7512
Practice Address - Country:US
Practice Address - Phone:970-456-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist