Provider Demographics
NPI:1689706269
Name:ROSS, RONALD WINES (ATC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WINES
Last Name:ROSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-4851
Mailing Address - Country:US
Mailing Address - Phone:724-941-6838
Mailing Address - Fax:
Practice Address - Street 1:91 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2310
Practice Address - Country:US
Practice Address - Phone:412-466-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000703A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer