Provider Demographics
NPI:1548257397
Name:ROSS, MICHAEL J (PT ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ROSS
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24014 W RENWICK RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8711
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:2260 W HIGGINS RD STE 104
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2432
Practice Address - Country:US
Practice Address - Phone:800-974-4378
Practice Address - Fax:630-515-1536
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2023-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070.027599225100000X
CT005898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004053294Medicaid
CT004053294Medicaid