Provider Demographics
NPI:1437519899
Name:ALLISON, ROSS (OT/PT/ROTATIONAL REF)
Entity Type:Individual
Prefix:PROF
First Name:ROSS
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:OT/PT/ROTATIONAL REF
Other - Prefix:
Other - First Name:ROSS
Other - Middle Name:MCKINLEY-MCCARTNEY
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PRACTITIONER-LMP-LMT
Mailing Address - Street 1:90 W MADISON AVE
Mailing Address - Street 2:SUITE E-246
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3955
Mailing Address - Country:US
Mailing Address - Phone:206-234-3087
Mailing Address - Fax:
Practice Address - Street 1:1940 W DICKERSON ST STE 102
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:206-234-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLIC-LIC-8077172M00000X
IDMASG-529172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist