Provider Demographics
NPI:1346834306
Name:ROSS, NATE TYRONE JR (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:NATE
Middle Name:TYRONE
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W RUTGERS CT
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3402
Mailing Address - Country:US
Mailing Address - Phone:609-705-1303
Mailing Address - Fax:
Practice Address - Street 1:143 W RUTGERS CT
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-3402
Practice Address - Country:US
Practice Address - Phone:609-705-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01389500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist