Provider Demographics
NPI:1518023555
Name:ROSS, CHAD (PT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 W DIMOND BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4517
Mailing Address - Country:US
Mailing Address - Phone:907-349-5801
Mailing Address - Fax:907-349-5802
Practice Address - Street 1:2203 W DIMOND BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4517
Practice Address - Country:US
Practice Address - Phone:907-349-5801
Practice Address - Fax:907-349-5802
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT1342Medicaid
AKPT1342Medicaid