Provider Demographics
NPI:1184686453
Name:ROSS, PHYLLIS R (OTR/L, CHT, CLT)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:OTR/L, CHT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 KANAWAH RUN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2780
Mailing Address - Country:US
Mailing Address - Phone:757-595-4880
Mailing Address - Fax:757-595-4886
Practice Address - Street 1:11712 JEFFERSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4406
Practice Address - Country:US
Practice Address - Phone:757-595-4880
Practice Address - Fax:757-595-4886
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002028225X00000X, 225XH1200X, 225XH1300X, 225XN1300X, 225XP0200X, 226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008948721Medicaid
VA2101706OtherALLIANCE PPO
VA462361OtherANTHEM BC/BS
VA7202455OtherAETNA
VA2101706OtherMAMSI / GEHA
VA2062541OtherMAIL HANDLERS BENIFITS
VAP00204753OtherMEDICARE RAILROAD
VA70510OtherVETRI SYSTEMS
VA7202455OtherAETNA
VAP00204753OtherMEDICARE RAILROAD