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General NPI Number Information
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NPI Number | 1154467207
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Entity Type | Individual
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Provider Name | TAMARA PETIGROW ROSS MSPT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 25 LITTLE PLAINS RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-4550
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Country | US
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Telephone | 631-266-4472
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Fax |
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Provider Business Mailing Address
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Address Line | 79 CHERRY LN
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City | SYOSSET
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State | NY
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Zip | 11791-1811
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Country | US
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Telephone | 631-704-9051
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 022526
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License Number State | NY
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