Provider Demographics
NPI:1487621397
Name:ROSA, MELANIE MAE (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MAE
Last Name:ROSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1500
Mailing Address - Country:US
Mailing Address - Phone:406-723-4268
Mailing Address - Fax:406-723-4274
Practice Address - Street 1:200 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1500
Practice Address - Country:US
Practice Address - Phone:406-723-4268
Practice Address - Fax:406-723-4274
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT381PT225100000X
225100000X
MT381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1821118423Medicaid
MT61108OtherBLUE CROSS/BLUE SHIELD
MT650025160OtherRAILROAD MEDICARE
MT0348585Medicaid