Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501003706 | MI |
NPI | 1346742087 |
---|---|
Provider Name | Joseph Dean Ross |
First Address | Grand Rapids, MI 49506-2921 |
Second Address | Grand Rapids, MI 49506-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |