Provider Demographics
NPI:1174751937
Name:ROSES, MARCIA SIROTKIN (LPT)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:SIROTKIN
Last Name:ROSES
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ROSES
Other - Last Name:SCHACHTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:411 N. NEW RIVER DR
Mailing Address - Street 2:STE 3403
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301
Mailing Address - Country:US
Mailing Address - Phone:646-263-0595
Mailing Address - Fax:954-764-7211
Practice Address - Street 1:411 N. NEW RIVER DR
Practice Address - Street 2:STE 3403
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:646-263-0595
Practice Address - Fax:954-764-7211
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24562225100000X
NC522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54 2075 250Medicare UPIN