Individual
CLINT MATTHEW ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
200 BIRCH ST, JACKSON, TN 38301-6684
(731) 422-5641
Mailing address
2625 WILSON SCHOOL RD, HENDERSON, TN 38340-3767
(731) 435-0135
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0000005298
TN
Other
Enumeration date
01/27/2013
Last updated
01/27/2013
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