Provider Demographics
NPI:1477611747
Name:ROSS PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ROSS PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-633-8040
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-0444
Mailing Address - Country:US
Mailing Address - Phone:860-633-8040
Mailing Address - Fax:860-633-8047
Practice Address - Street 1:52 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1212
Practice Address - Country:US
Practice Address - Phone:860-633-8040
Practice Address - Fax:860-633-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080004782CT16OtherBCBS
CT4339765OtherAETNA
CT2V8218OtherHEALTHNET
CT32301OtherCIGNA ORTHO
CT=========OtherNORTHEAST HEALTH DIRECT
CT32301OtherCIGNA ORTHO