Provider Demographics
NPI:1831897727
Name:ROSS, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WONSETTLER RD
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1863
Mailing Address - Country:US
Mailing Address - Phone:724-945-5161
Mailing Address - Fax:724-945-5164
Practice Address - Street 1:100 WONSETTLER RD
Practice Address - Street 2:
Practice Address - City:SCENERY HILL
Practice Address - State:PA
Practice Address - Zip Code:15360-1863
Practice Address - Country:US
Practice Address - Phone:724-945-5161
Practice Address - Fax:724-945-5164
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist