Provider Demographics
NPI:1346406832
Name:ROSS, KAREN L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8567
Mailing Address - Country:US
Mailing Address - Phone:815-455-3062
Mailing Address - Fax:
Practice Address - Street 1:411 NORTHWEST PROFESSIONAL CENTER
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-459-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.001036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist