Provider Demographics
NPI:1700998952
Name:ROSS J. DOVER, PT
Entity Type:Organization
Organization Name:ROSS J. DOVER, PT
Other - Org Name:THERAPYWORKS-FITNESSWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-772-7358
Mailing Address - Street 1:500 QUINTANA RD
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1938
Mailing Address - Country:US
Mailing Address - Phone:805-772-7358
Mailing Address - Fax:805-772-0409
Practice Address - Street 1:500 QUINTANA RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1938
Practice Address - Country:US
Practice Address - Phone:805-772-7358
Practice Address - Fax:805-772-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376590885OtherNPI INDIVIDUAL
CA1376590885OtherNPI INDIVIDUAL
CAPT12081Medicare ID - Type Unspecified