Provider Demographics
NPI:1750664843
Name:ROSS, LINDA K (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
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 1:9086 PIGEON ROOST RD STE 107
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1692
Mailing Address - Country:US
Mailing Address - Phone:901-318-5832
Mailing Address - Fax:
Practice Address - Street 1:9086 PIGEON ROOST RD STE 107
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1692
Practice Address - Country:US
Practice Address - Phone:901-318-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7096172M00000X
MS2403172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist