Provider Demographics
NPI:1033185996
Name:ROSS, MARK DAVID (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:ROSS
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SAVONA
Mailing Address - State:NY
Mailing Address - Zip Code:14879-0422
Mailing Address - Country:US
Mailing Address - Phone:740-707-1363
Mailing Address - Fax:
Practice Address - Street 1:2345 MAIN ST
Practice Address - Street 2:HEALTHTRAX INTERNATIONAL INC.
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2211
Practice Address - Country:US
Practice Address - Phone:716-879-5023
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer