Basic Information
| Provider Information | |||||||||
| NPI: | 1366172587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6503 STATE ROUTE 209 | ||||||||
| Address2: | |||||||||
| City: | LYKENS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170489606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173071585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 TREMONT RD | ||||||||
| Address2: | |||||||||
| City: | PINE GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179638629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709154160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2022 | ||||||||
| LastUpdateDate: | 06/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.