Provider Demographics
NPI:1942586557
Name:DEROSAS, KAREN ANN (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:DEROSAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:DEROSAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1540
Mailing Address - Country:US
Mailing Address - Phone:781-275-7651
Mailing Address - Fax:
Practice Address - Street 1:3 PUTNAM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1540
Practice Address - Country:US
Practice Address - Phone:781-275-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113732251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics