Provider Demographics
NPI:1710918396
Name:ROSS, TRAVIS (DPT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300 / FINANCE DEPARTMENT
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-623-7228
Mailing Address - Fax:302-623-7425
Practice Address - Street 1:300 BIDDLE AVE
Practice Address - Street 2:CONNOR BUILDING, SUITE 101
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3969
Practice Address - Country:US
Practice Address - Phone:302-838-4700
Practice Address - Fax:302-838-4710
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist