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General NPI Number Information
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NPI Number | 1144455544
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Entity Type | Individual
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Provider Name | DOMINIQUE MATHIEU ROSS PHD, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 1844 COMMONWEALTH AVE
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City | AUBURNDALE
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State | MA
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Zip | 02466-2709
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Country | US
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Telephone | 617-243-2413
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Fax |
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Provider Business Mailing Address
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Address Line | 1844 COMMONWEALTH AVE
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City | AUBURNDALE
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State | MA
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Zip | 02466-2709
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Country | US
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Telephone | 207-576-6239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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