Basic Information
| Provider Information | |||||||||
| NPI: | 1730142001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | |||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7515 FREDLE DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD TWP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440779406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403520400 | ||||||||
| FaxNumber: | 4403524535 | ||||||||
| Practice Location | |||||||||
| Address1: | 7515 FREDLE DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD TWP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440779406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403520400 | ||||||||
| FaxNumber: | 4403524535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4934 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2489856 | 05 | OH | MEDICAID |