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General NPI Number Information
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NPI Number | 1477611747
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Entity Type | Organization
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Legal Business Name | ROSS PHYSICAL THERAPY SERVICES LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 52 NATIONAL DR
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City | GLASTONBURY
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State | CT
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Zip | 06033-1212
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Country | US
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Telephone | 860-633-8040
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Fax | 860-633-8047
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | GLASTONBURY
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State | CT
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Zip | 06033-0444
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Country | US
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Telephone | 860-633-8040
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Fax | 860-633-8047
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD L ROSS
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Credential | PT
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Telephone | 860-633-8040
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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 | 004782
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License Number State | CT
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