Provider Demographics
NPI:1962101097
Name:ROSE REHAB AND PERFORMANCE, PLLC
Entity type:Organization
Organization Name:ROSE REHAB AND PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:319-325-8089
Mailing Address - Street 1:11 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2400
Mailing Address - Country:US
Mailing Address - Phone:319-325-8089
Mailing Address - Fax:
Practice Address - Street 1:123 BOULEVARD RD
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2318
Practice Address - Country:US
Practice Address - Phone:319-325-8089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty