Provider Demographics
NPI:1821115619
Name:ROSS, DANIELLE RENEE (ATC, MA, BS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENEE
Last Name:ROSS
Suffix:
Gender:F
Credentials:ATC, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3609 BIRDSONG CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-7222
Mailing Address - Country:US
Mailing Address - Phone:804-317-4984
Mailing Address - Fax:
Practice Address - Street 1:1730 KERNERSVILLE MEDICAL PKWY STE 204
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7198
Practice Address - Country:US
Practice Address - Phone:336-277-4460
Practice Address - Fax:336-992-2674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126 0006612255A2300X
NCLAT-22012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer