Most Relevant Information
Provider Data
| NPI Number: | 1003026311 |
| Provider Name: | KELLYANNE ROSE |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | AT8276 |
Most Important Dates
| Enumeration Date: | 05/23/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
9000 WAKARUSA ST
LA MESA
CA
919423307
Practice Location Phone/Fax
| Phone: | 6197404600 |
| Fax: |
Provider Mailing Location
3706 GEORGIA ST
APT 8
SAN DIEGO
CA
921037625
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |