Provider Demographics
NPI:1518001056
Name:ROZINA, MARY E (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:ROZINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3770
Mailing Address - Country:US
Mailing Address - Phone:909-985-8686
Mailing Address - Fax:909-985-5706
Practice Address - Street 1:846 W FOOTHILL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3770
Practice Address - Country:US
Practice Address - Phone:909-985-8686
Practice Address - Fax:909-985-5706
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT234691Medicare PIN
CAZZZ07332ZMedicare PIN