Provider Demographics
NPI:1275688764
Name:ROSS, JAMES THOMAS (DPM, PT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPM, PT
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Mailing Address - Street 1:1015 CANYON MEADOW DR
Mailing Address - Street 2:CONDO # 5
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3623
Mailing Address - Country:US
Mailing Address - Phone:801-356-1733
Mailing Address - Fax:
Practice Address - Street 1:1015 CANYON MEADOW DR
Practice Address - Street 2:# 5
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3623
Practice Address - Country:US
Practice Address - Phone:801-356-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110261-0501213E00000X
WA8154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist