Provider Demographics
NPI:1760180764
Name:ROSS PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:ROSS PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:325-716-9443
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:LIPAN
Mailing Address - State:TX
Mailing Address - Zip Code:76462-0119
Mailing Address - Country:US
Mailing Address - Phone:325-716-9443
Mailing Address - Fax:
Practice Address - Street 1:215 W LIPAN DR
Practice Address - Street 2:
Practice Address - City:LIPAN
Practice Address - State:TX
Practice Address - Zip Code:76462-2001
Practice Address - Country:US
Practice Address - Phone:325-716-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty