Provider Demographics
NPI:1568759496
Name:POPE, ROSS E (PT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:E
Last Name:POPE
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:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-1004
Mailing Address - Country:US
Mailing Address - Phone:731-613-2214
Mailing Address - Fax:731-613-2215
Practice Address - Street 1:126 DAVY CROCKETT MALL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2934
Practice Address - Country:US
Practice Address - Phone:731-855-2221
Practice Address - Fax:731-855-2204
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist