Provider Demographics
NPI:1386776946
Name:ROB ROSENBERRY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:ROB ROSENBERRY PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-688-5000
Mailing Address - Street 1:320 ALISAL RD
Mailing Address - Street 2:SUITE # 406
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3735
Mailing Address - Country:US
Mailing Address - Phone:805-688-5000
Mailing Address - Fax:
Practice Address - Street 1:320 ALISAL RD
Practice Address - Street 2:SUITE # 406
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3735
Practice Address - Country:US
Practice Address - Phone:805-688-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19421Medicare PIN