Provider Demographics
NPI:1952318859
Name:ROSS, TRACY WILLIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:WILLIAM
Last Name:ROSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OAK LANE
Mailing Address - Street 2:
Mailing Address - City:STEVENS
Mailing Address - State:PA
Mailing Address - Zip Code:17578-9706
Mailing Address - Country:US
Mailing Address - Phone:717-336-5335
Mailing Address - Fax:717-336-1418
Practice Address - Street 1:SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-0800
Practice Address - Country:US
Practice Address - Phone:717-336-1423
Practice Address - Fax:717-336-1418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine