Provider Demographics
NPI:1275750929
Name:ROSS, SUSAN D (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
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 1:779 SILVERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4620
Mailing Address - Country:US
Mailing Address - Phone:330-463-5588
Mailing Address - Fax:
Practice Address - Street 1:209 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1904
Practice Address - Country:US
Practice Address - Phone:330-761-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist