Provider Demographics
NPI:1144559089
Name:ROSA, JULIE ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:JULIE ANN
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47550 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2510
Mailing Address - Country:US
Mailing Address - Phone:586-580-3216
Mailing Address - Fax:
Practice Address - Street 1:15501 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1684
Practice Address - Country:US
Practice Address - Phone:586-228-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant