Provider Demographics
NPI:1194103929
Name:ROSE, MEAGAN (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:MAASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1769 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-1136
Mailing Address - Country:US
Mailing Address - Phone:619-421-6083
Mailing Address - Fax:619-482-8284
Practice Address - Street 1:510 E NAPLES ST # 604
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2519
Practice Address - Country:US
Practice Address - Phone:619-421-6083
Practice Address - Fax:619-482-8284
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist