Provider Demographics
NPI:1356134969
Name:ROOSA, BRYAN ANDREW
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANDREW
Last Name:ROOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6308
Mailing Address - Country:US
Mailing Address - Phone:234-378-6355
Mailing Address - Fax:
Practice Address - Street 1:121 13TH ST SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6308
Practice Address - Country:US
Practice Address - Phone:234-378-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide