Provider Demographics
NPI:1083377493
Name:GROSS, SETH W (DPT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:W
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 INTERNATIONAL PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1864
Mailing Address - Country:US
Mailing Address - Phone:972-845-7875
Mailing Address - Fax:
Practice Address - Street 1:1761 INTERNATIONAL PKWY STE 135
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1864
Practice Address - Country:US
Practice Address - Phone:972-845-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13521032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic