| Doctor Name: | RODERICK GAMBOA STA ROSA |
| NPI Number: | 1790957678 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 40QA00417800 |
| Business Practice Address: | 303 W Main St Suite B18 Freehold, NJ - 077284832 |
| Business Phone Number: | 7324318900 |
| Business Fax Number: | 7324310244 |
| Mailing Address: | 4175 Veterans Memorial Hwy, Suite 202 RONKONKOMA |
| State: | NY |
| Postal Code: | 117797639 |
| Phone Number: | 6315805200 |
| Fax Number: | 6315805222 |
| NPI Enumeration Date: | 03/31/2008 |
| NPI Last Update Date: | 05/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA00417800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |