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NPI Code Detail

MEDICARE: MR. ROSS M PFAFF PTA, ATC

MEDICARE: MR. ROSS M PFAFF PTA, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist36001064AIN
2225200000XPhysical Therapy Assistant2092898TX

General Provider Information

NPI Number : 1578647012
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROSS M PFAFF PTA, ATC
Provider Business Mailing Address
First Line : 12456 GREY TWIG DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5546
Country : US
Telephone Number : 317-965-7221
Fax Number :
Provider Business Practice Location Address
First Line : 5801 BRYANT IRVIN RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4209
Country : US
Telephone Number : 817-988-6873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 12/30/2014

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