Provider Demographics
NPI:1962469205
Name:ROSS, MICHAEL E (ATC, PTA, CPE)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:ATC, PTA, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24632 ZENA CT
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4736
Mailing Address - Country:US
Mailing Address - Phone:949-581-9363
Mailing Address - Fax:
Practice Address - Street 1:24632 ZENA CT
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4736
Practice Address - Country:US
Practice Address - Phone:949-581-9363
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1304225200000X
804822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer