Provider Demographics
NPI:1659790129
Name:ROSS, LINDA (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MURPHY RD LOT 1
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16134-9607
Mailing Address - Country:US
Mailing Address - Phone:724-456-3901
Mailing Address - Fax:
Practice Address - Street 1:164 MURPHY RD LOT 1
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:PA
Practice Address - Zip Code:16134-9607
Practice Address - Country:US
Practice Address - Phone:724-456-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH018999225700000X
PAMSG003282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist