Provider Demographics
NPI:1144455544
Name:ROSS, DOMINIQUE MATHIEU (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:MATHIEU
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2709
Mailing Address - Country:US
Mailing Address - Phone:207-576-6239
Mailing Address - Fax:
Practice Address - Street 1:1844 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2709
Practice Address - Country:US
Practice Address - Phone:617-243-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer