Provider Demographics
NPI:1013233634
Name:ROS, GRZEGORZ (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:ROS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 PEACE WAY
Mailing Address - Street 2:2019
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8256
Mailing Address - Country:US
Mailing Address - Phone:702-325-8644
Mailing Address - Fax:
Practice Address - Street 1:5920 S RAINBOW BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4208
Practice Address - Country:US
Practice Address - Phone:702-248-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2413261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36885Medicare PIN
NVDI575ZMedicare PIN