Provider Demographics
NPI:1174555254
Name:ROSETTE, EDWARD (LPT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:ROSETTE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 MOOSE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1710
Mailing Address - Country:US
Mailing Address - Phone:406-585-4642
Mailing Address - Fax:406-585-2878
Practice Address - Street 1:1648 ELLIS ST STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:406-585-4642
Practice Address - Fax:406-585-2878
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1212PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist