Provider Demographics
NPI:1174907497
Name:ROSSI, ANTHONY MICHAEL (ATC, CSCS, NREMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:ROSSI
Suffix:
Gender:M
Credentials:ATC, CSCS, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SAND CREEK HWY
Mailing Address - Street 2:APARTMENT H
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9175
Mailing Address - Country:US
Mailing Address - Phone:248-343-0678
Mailing Address - Fax:517-264-3869
Practice Address - Street 1:110 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2518
Practice Address - Country:US
Practice Address - Phone:517-264-3969
Practice Address - Fax:517-264-3869
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3203057349146N00000X
MI26010015122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic