Provider Demographics
NPI:1912320227
Name:ROSS, MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4433
Mailing Address - Country:US
Mailing Address - Phone:330-655-8070
Mailing Address - Fax:
Practice Address - Street 1:5625 HUDSON DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4433
Practice Address - Country:US
Practice Address - Phone:330-655-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist