=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255336509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN S. ROSS MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2005
-----------------------------------------------------
Last Update Date | 10/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 W 67TH CT
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-1177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-663-3302
-----------------------------------------------------
Fax | 970-663-5255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 W 67TH CT
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-1177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-663-3302
-----------------------------------------------------
Fax | 970-663-5255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8181
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------