Provider Demographics
NPI:1053032375
Name:ROSE, ELYSSA ANNE (ATS)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:ANNE
Last Name:ROSE
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6761 NE VININGS WAY APT 638
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7971
Mailing Address - Country:US
Mailing Address - Phone:541-991-2455
Mailing Address - Fax:
Practice Address - Street 1:6761 NE VININGS WAY APT 638
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7971
Practice Address - Country:US
Practice Address - Phone:541-991-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer