Provider Demographics
NPI:1154954402
Name:ROSALES, GEA GABRIELLE SERAFICA (PT)
Entity type:Individual
Prefix:MISS
First Name:GEA GABRIELLE
Middle Name:SERAFICA
Last Name:ROSALES
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 1:2013 ELKINS WAY STE C
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7380
Mailing Address - Country:US
Mailing Address - Phone:925-513-2252
Mailing Address - Fax:
Practice Address - Street 1:2013 ELKINS WAY STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7380
Practice Address - Country:US
Practice Address - Phone:925-513-2252
Practice Address - Fax:925-513-2253
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty