Provider Demographics
NPI:1679795587
Name:ROSS, DARLEEN MARIE (PT)
Entity type:Individual
Prefix:
First Name:DARLEEN
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-9239
Mailing Address - Country:US
Mailing Address - Phone:724-238-9185
Mailing Address - Fax:
Practice Address - Street 1:1865 ROUTE 30
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9239
Practice Address - Country:US
Practice Address - Phone:724-238-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006236L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA714798Medicare ID - Type Unspecified
PAS71559Medicare UPIN