Provider Demographics
NPI:1023058997
Name:ROSS, ANDREA (PT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
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:ONE GARNETT LANE
Mailing Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1414
Mailing Address - Country:US
Mailing Address - Phone:401-949-0380
Mailing Address - Fax:401-949-5581
Practice Address - Street 1:ONE GARNETT LANE
Practice Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1414
Practice Address - Country:US
Practice Address - Phone:401-949-0380
Practice Address - Fax:401-949-5581
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
050456866OtherTAX ID
RI75275OtherRI BLUE CROSS
6400148OtherUNITED HEALTH OF NEW ENGL
RI26679OtherNEIGHBORHOOD PIN
RI8225OtherNEIGHBORHOOD PIN GROUP
RI402512OtherRI BLUE CHIP
RI26679OtherNEIGHBORHOOD PIN
007001716Medicare UPIN