Provider Demographics
NPI:1265545453
Name:GROSS, JEREME RYAN (PT)
Entity type:Individual
Prefix:
First Name:JEREME
Middle Name:RYAN
Last Name:GROSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1501
Mailing Address - Country:US
Mailing Address - Phone:717-731-6094
Mailing Address - Fax:717-731-6199
Practice Address - Street 1:920 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-8417
Practice Address - Country:US
Practice Address - Phone:717-591-1331
Practice Address - Fax:717-591-1332
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117807UBMMedicare UPIN