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NPI Code Detail

MEDICARE: MRS. TAMARA PETIGROW ROSS MSPT

MEDICARE: MRS. TAMARA PETIGROW ROSS MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist022526NY

General Provider Information

NPI Number : 1154467207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMARA PETIGROW ROSS MSPT
Provider Business Mailing Address
First Line : 79 CHERRY LN
Second Line :
City : SYOSSET
State : NY
Zip : 11791-1811
Country : US
Telephone Number : 631-704-9051
Fax Number :
Provider Business Practice Location Address
First Line : 25 LITTLE PLAINS RD
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4550
Country : US
Telephone Number : 631-266-4472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 03/23/2021

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