Provider Demographics
NPI:1376590885
Name:DOVER, ROSS J (PT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:J
Last Name:DOVER
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 1:500 QUINTANA RD
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1938
Mailing Address - Country:US
Mailing Address - Phone:805-772-7358
Mailing Address - Fax:805-772-0409
Practice Address - Street 1:500 QUINTANA RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1938
Practice Address - Country:US
Practice Address - Phone:805-772-7358
Practice Address - Fax:805-772-0409
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R36159Medicare UPIN