Provider Demographics
NPI:1801978317
Name:ROSE, STEPHEN CRAIG (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:ROSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1938
Mailing Address - Country:US
Mailing Address - Phone:559-782-7670
Mailing Address - Fax:
Practice Address - Street 1:661 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1938
Practice Address - Country:US
Practice Address - Phone:559-782-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0OtherI HAVE NO MEDICARE OR MEDICAID CONTRACTS