Provider Demographics
NPI:1487863114
Name:CROSS, PAULA A (PHYS THERAPIST ASST)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:A
Last Name:CROSS
Suffix:
Gender:F
Credentials:PHYS THERAPIST ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 W 73RD PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4501
Mailing Address - Country:US
Mailing Address - Phone:219-769-6006
Mailing Address - Fax:
Practice Address - Street 1:8380 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6231
Practice Address - Country:US
Practice Address - Phone:219-769-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002522A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant