Healthcare Provider Details

I. General information

NPI: 1952318859
Provider Name (Legal Business Name): TRACY WILLIAM ROSS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH 4TH STREET
DENVER PA
17517-0800
US

IV. Provider business mailing address

5 OAK LANE
STEVENS PA
17578-9706
US

V. Phone/Fax

Practice location:
  • Phone: 717-336-1423
  • Fax: 717-336-1418
Mailing address:
  • Phone: 717-336-5335
  • Fax: 717-336-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: