Provider Demographics
NPI:1104966472
Name:ROSINA, ANNMARIE (PT)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:ROSINA
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 1:16 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2007
Mailing Address - Country:US
Mailing Address - Phone:631-375-8530
Mailing Address - Fax:631-780-6689
Practice Address - Street 1:16 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2007
Practice Address - Country:US
Practice Address - Phone:631-375-8530
Practice Address - Fax:631-780-6689
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist