Provider Demographics
NPI:1174344980
Name:ROSS, TROY
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INDIAN RUIN RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7346
Mailing Address - Country:US
Mailing Address - Phone:313-580-4339
Mailing Address - Fax:
Practice Address - Street 1:251 JORDAN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336
Practice Address - Country:US
Practice Address - Phone:928-963-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist