1477611747 NPI number — ROSS PHYSICAL THERAPY SERVICES LLC

Table of content: (NPI 1477611747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477611747 NPI number — ROSS PHYSICAL THERAPY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS PHYSICAL THERAPY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477611747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 444
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-0444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-633-8040
Provider Business Mailing Address Fax Number:
860-633-8047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 NATIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06033-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-633-8040
Provider Business Practice Location Address Fax Number:
860-633-8047
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-633-8040

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004782 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080004782CT16 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4339765 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V8218 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 32301 . This is a "CIGNA ORTHO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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