MEDICARE: RUTH ROSS PT, DPT, OCS

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	CP052806T	MO
2	225100000X	Physical Therapist	PT4472	AR
3	2251X0800X	Orthopedic Physical Therapist	PT4472	AR

General Provider Information

NPI Number	:	1750865044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ROSS PT, DPT, OCS

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-2941
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 W PLEASANT GROVE RD
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-5804
Country	:	US
Telephone Number	:	479-636-1197
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	01/26/2026

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