Provider Demographics
NPI:1083751531
Name:ROSS, TERESA C (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:C
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15745 DORA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4943
Mailing Address - Country:US
Mailing Address - Phone:352-357-8358
Mailing Address - Fax:352-357-0618
Practice Address - Street 1:15745 DORA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4943
Practice Address - Country:US
Practice Address - Phone:352-357-8358
Practice Address - Fax:352-357-0618
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG01136900125Medicare ID - Type UnspecifiedMEDICARE ID