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NPI Code Detail

MEDICARE: JEFFERY ROBERT GROSS PTA

MEDICARE: JEFFERY ROBERT GROSS PTA
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
1225200000XPhysical Therapy AssistantA02416KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100000000OTHERN/A

General Provider Information

NPI Number : 1942795521
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY ROBERT GROSS PTA
Provider Business Mailing Address
First Line : 43 GROSS LOOP
Second Line :
City : JACKSON
State : KY
Zip : 41339-8625
Country : US
Telephone Number : 606-272-1969
Fax Number :
Provider Business Practice Location Address
First Line : 1376 SILVER SPRINGS DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40511-2319
Country : US
Telephone Number : 859-277-0320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2018
Last Update Date : 06/26/2018

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