Provider Demographics
NPI:1306411038
Name:ROSE, ELIZABETH DURRETT (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DURRETT
Last Name:ROSE
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 CAP ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3419
Mailing Address - Country:US
Mailing Address - Phone:214-991-1432
Mailing Address - Fax:
Practice Address - Street 1:2038 CAP ROCK DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3419
Practice Address - Country:US
Practice Address - Phone:214-991-1432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist