Provider Demographics
NPI:1144042078
Name:ROSELL, TYLER PASANA (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:PASANA
Last Name:ROSELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 ORANGE AVENUE UNIT G37
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723
Mailing Address - Country:US
Mailing Address - Phone:951-259-7991
Mailing Address - Fax:
Practice Address - Street 1:4300 LONG BEACH BLVD
Practice Address - Street 2:STE 700
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:877-757-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist