MEDICARE: MRS. SUSAN D ROSS PT

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
1	225100000X	Physical Therapist	PT008004	OH

General Provider Information

NPI Number	:	1275750929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN D ROSS PT

Provider Business Mailing Address
First Line	:	779 SILVERBERRY LN
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-4620
Country	:	US
Telephone Number	:	330-463-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 MERRIMAN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-1904
Country	:	US
Telephone Number	:	330-761-9163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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