Provider Demographics
NPI:1932403359
Name:ROSEBOROUGH, KATHERINE G (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:ROSEBOROUGH
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 1:169 MADISON AVE STE 15501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5101
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:169 MADISON AVE STE 15501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5101
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032122225100000X
FLPT27130225100000X
MN13416225100000X
MD30530225100000X
OHPT022015225100000X
NY054523225100000X
CA308808225100000X
MAPTL88915225100000X
AZLPT-033470225100000X
NMPT-2025-0195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932403359Medicaid
VA9340647OtherAETNA
VA298498OtherBCBS (PHYSICAL THERAPY)
VA298498OtherBCBS (PHYSICAL THERAPY)
VA1932403359Medicaid