Provider Demographics
NPI:1477594109
Name:PHILLIP ROSS PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:PHILLIP ROSS PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-487-0559
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-0941
Mailing Address - Country:US
Mailing Address - Phone:270-487-0559
Mailing Address - Fax:
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1002
Practice Address - Country:US
Practice Address - Phone:270-487-0913
Practice Address - Fax:270-487-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT003345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty