Provider Demographics
NPI:1609033414
Name:ROSS, RUTH M (PT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
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 6626
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0626
Mailing Address - Country:US
Mailing Address - Phone:580-355-1766
Mailing Address - Fax:580-357-5780
Practice Address - Street 1:2716 WEST GORE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-355-1766
Practice Address - Fax:580-357-8750
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist