Individual
MARY K ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
325 S 1ST AVE, BROKEN BOW, NE 68822-2213
(308) 872-5111
(308) 872-5115
Mailing address
325 S 1ST AVE, PO BOX 435, BROKEN BOW, NE 68822-2213
(308) 872-5111
(308) 872-5115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1511
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39519
BLUE CROSS BLUE SHIELD
NE
Enumeration date
09/20/2006
Last updated
04/21/2017
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