Provider Demographics
NPI:1285971259
Name:ROSE HEBAR PHYSICAL THERAPIST, LLC
Entity type:Organization
Organization Name:ROSE HEBAR PHYSICAL THERAPIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEBAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:262-363-0555
Mailing Address - Street 1:555 BAY VIEW RD
Mailing Address - Street 2:#2
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1750
Mailing Address - Country:US
Mailing Address - Phone:262-363-0555
Mailing Address - Fax:262-363-0572
Practice Address - Street 1:555 BAY VIEW RD
Practice Address - Street 2:#2
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1750
Practice Address - Country:US
Practice Address - Phone:262-363-0555
Practice Address - Fax:262-363-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy