MEDICARE: DR. JACLYN BROOKE ROSS PT, DPT, CSRS

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1689500431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN BROOKE ROSS PT, DPT, CSRS

Provider Business Mailing Address
First Line	:	2999 OLYMPUS BLVD STE 500
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13659 E 104TH AVE UNIT 300
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9402
Country	:	US
Telephone Number	:	720-506-5340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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