Provider Demographics
NPI:1467457713
Name:ROSS, ANDREW L (MPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:RED FEATHER LAKES
Mailing Address - State:CO
Mailing Address - Zip Code:80545-0037
Mailing Address - Country:US
Mailing Address - Phone:970-223-2484
Mailing Address - Fax:970-223-6156
Practice Address - Street 1:17931 RED FEATHER LAKES RD
Practice Address - Street 2:
Practice Address - City:RED FEATHER LAKES
Practice Address - State:CO
Practice Address - Zip Code:80545-9410
Practice Address - Country:US
Practice Address - Phone:970-223-2484
Practice Address - Fax:970-223-6156
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC513868Medicare PIN