Provider Demographics
NPI:1659354009
Name:ROSS, KRISTEN ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TOTMAN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7564
Mailing Address - Country:US
Mailing Address - Phone:617-770-4167
Mailing Address - Fax:617-770-0971
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-770-4167
Practice Address - Fax:617-770-0971
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68503OtherBCBS
Y69677Medicare PIN