Provider Demographics
NPI:1649391376
Name:ROSS, SCOTT E (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 ABBOTTS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3234
Mailing Address - Country:US
Mailing Address - Phone:804-378-2871
Mailing Address - Fax:
Practice Address - Street 1:1015 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-2020
Practice Address - Country:US
Practice Address - Phone:804-828-1948
Practice Address - Fax:804-828-1946
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer