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General NPI Number Information
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NPI Number | 1851824668
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Entity Type | Individual
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Provider Name | DOUGLAS COLE ROSS ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | ASU STATION 10889
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City | SAN ANGELO
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State | TX
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Zip | 76909-0899
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Country | US
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Telephone | 919-943-2865
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 PRINCETON AVE
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City | SAN ANGELO
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State | TX
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Zip | 76904-5840
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Country | US
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Telephone | 919-943-2865
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | AT6463
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License Number State | TX
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