Healthcare Provider Details

I. General information

NPI: 1649391376
Provider Name (Legal Business Name): SCOTT E ROSS PHD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W. MAIN ST
RICHMOND VA
23284-2020
US

IV. Provider business mailing address

1723 ABBOTTS MILL WAY
MIDLOTHIAN VA
23114-3234
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-1948
  • Fax: 804-828-1946
Mailing address:
  • Phone: 804-378-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: