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General NPI Number Information
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NPI Number | 1235371121
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Entity Type | Individual
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Provider Name | JEANIE ROSS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 141 STONECREST RD STE 2
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City | SHELBYVILLE
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State | KY
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Zip | 40065-8166
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Country | US
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Telephone | 502-647-0133
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Fax | 502-647-0138
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Provider Business Mailing Address
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Address Line | 624 ASHBOURNE DR
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City | SHELBYVILLE
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State | KY
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Zip | 40065-7394
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Country | US
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Telephone | 502-647-7307
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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 | 002048
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License Number State | KY
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