Provider Demographics
NPI:1851824668
Name:ROSS, DOUGLAS COLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:COLE
Last Name:ROSS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5840
Mailing Address - Country:US
Mailing Address - Phone:919-943-2865
Mailing Address - Fax:
Practice Address - Street 1:ASU STATION 10889
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76909-0899
Practice Address - Country:US
Practice Address - Phone:919-943-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT6463390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program