Provider Demographics
NPI:1881921435
Name:ROSS, MALISSA S (MS, PT)
Entity type:Individual
Prefix:
First Name:MALISSA
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8859 FOX DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6899
Mailing Address - Country:US
Mailing Address - Phone:303-428-4646
Mailing Address - Fax:303-429-6255
Practice Address - Street 1:8859 FOX DR
Practice Address - Street 2:SUITE 300
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6899
Practice Address - Country:US
Practice Address - Phone:303-428-4646
Practice Address - Fax:303-429-6255
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO10191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist