Provider Demographics
NPI:1417997651
Name:ROSS, LORI R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:R
Other - Last Name:NOTARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:680 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:440-478-4919
Mailing Address - Fax:330-928-4521
Practice Address - Street 1:680 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2407
Practice Address - Country:US
Practice Address - Phone:440-478-4919
Practice Address - Fax:330-928-4521
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7618OtherPT #
OHRO4184141Medicare UPIN