Provider Demographics
NPI:1760636419
Name:GROSS, MORRIS (PTA)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 KNUE RD
Mailing Address - Street 2:SUITE #112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1974
Mailing Address - Country:US
Mailing Address - Phone:317-841-7005
Mailing Address - Fax:317-841-7029
Practice Address - Street 1:8021 KNUE RD
Practice Address - Street 2:SUITE #112
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1974
Practice Address - Country:US
Practice Address - Phone:317-841-7005
Practice Address - Fax:317-841-7029
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001916A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant