Individual
MRS. JACQUELINE J ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1 DIANE DR, FORT ASHBY, WV 26719-0686
(304) 298-3602
Mailing address
PO BOX 686, FORT ASHBY, WV 26719-0686
(304) 298-3602
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0991
WV
225200000X
Physical Therapy Assistant
A2724
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0991
PHYSICAL THERAPIST ASSIST
WV
01
—
A2724
PHYSICAL THERAPIST ASSIT
MD
Enumeration date
03/16/2007
Last updated
07/08/2007
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