Provider Demographics
NPI:1073536868
Name:ROSS, LAWRENCE (RPT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-7523
Practice Address - Country:US
Practice Address - Phone:781-237-5585
Practice Address - Fax:781-237-5633
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
CT0027622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT18901OtherCIGNA/ORTHONET ID NUMBER
CTANC1685OtherOXFORD ID NUMBER
CT50RPTINC0CT01OtherBLUE CROSS BLUE SHIELD NU
CT764202OtherCONNECTICARE ID NUMBER
CT2019893OtherAETNA ID NUMBER