Provider Demographics
NPI:1225125511
Name:GROSS, DAVID ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:GROSS
Suffix:
Gender:M
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:PO BOX 15627
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-0627
Mailing Address - Country:US
Mailing Address - Phone:206-527-8628
Mailing Address - Fax:206-527-8648
Practice Address - Street 1:2319 N 45TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6982
Practice Address - Country:US
Practice Address - Phone:206-527-8628
Practice Address - Fax:206-527-8648
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60607OtherFIRST CHOICE
WA0201568OtherLABOR AND INDUSTRY
WA5623609OtherFIRST HEALTH
7775192OtherAETNA
1136229OtherCAQH
WA167753167755OtherPREMERA
WA8856436Medicare ID - Type Unspecified