=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811138761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL MEDICINE & ACUPUNCTURE,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2009
-----------------------------------------------------
Last Update Date | 03/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 N MILITARY TRL
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-275-2006
-----------------------------------------------------
Fax | 561-994-5445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 328 W GODFREY AVE SUITE 100
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19120-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-275-2006
-----------------------------------------------------
Fax | 215-549-4007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HARRIS A ROSS
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-275-2006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | OS 1567
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------