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General NPI Number Information
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NPI Number | 1700612926
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Entity Type | Individual
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Provider Name | ERIC ROSS POWELL PT
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Gender | Male
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 4000 HOLLYWOOD BLVD APT 600N
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6863
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Country | US
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Telephone | 928-201-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 2865 GRANDHILL RD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8512
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Country | US
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Telephone | 928-201-2334
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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 | 3298
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License Number State | AZ
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