Provider Demographics
NPI:1386940955
Name:ROSVOLD, RACHEL GIBIAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:GIBIAN
Last Name:ROSVOLD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 TARRAGON LN
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7264
Mailing Address - Country:US
Mailing Address - Phone:610-742-7856
Mailing Address - Fax:
Practice Address - Street 1:846 TARRAGON LN
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7264
Practice Address - Country:US
Practice Address - Phone:610-742-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033338-1225100000X
CA41133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist