Provider Demographics
NPI:1568446565
Name:ROSS, DAVID ALEXANDER (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:ALEXANDER
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT OCS
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:1005 N EVERGREEN RD
Practice Address - Street 2:STE 010
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1485
Practice Address - Country:US
Practice Address - Phone:509-926-5367
Practice Address - Fax:509-928-5508
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568446565Medicaid
WA8364473OtherWASHINGTON L&I
WA8364473Medicaid
WA0347330OtherWA L&I
WA1568446565Medicaid
WA8364473Medicaid
WAGAB28153Medicare PIN