Provider Demographics
NPI:1073053906
Name:ROSSI, JOHNANTHONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHNANTHONY
Middle Name:
Last Name:ROSSI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3238
Mailing Address - Country:US
Mailing Address - Phone:610-506-1062
Mailing Address - Fax:
Practice Address - Street 1:3011 FAIRHILL DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3238
Practice Address - Country:US
Practice Address - Phone:610-506-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART006123405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional