Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT017680 | PA |
NPI | 1356438725 |
---|---|
Provider Name | Megan D Ross |
First Address | Philadelphia, PA 19178-8500 |
Second Address | Warminster, PA 18974-3532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1900887 | HIGHMARK BS-PREMIER (01) | PA |