Provider Demographics
NPI:1851307995
Name:ROSS, BETH A (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:533 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1617
Practice Address - Country:US
Practice Address - Phone:812-759-3001
Practice Address - Fax:812-401-9013
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009014A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000484965OtherBLUE CROSS BLUE SHIELD
IN200829330Medicaid
IN198850LMedicare PIN
INP00375474Medicare UPIN
IN200829330Medicaid