Provider Demographics
NPI:1700612926
Name:POWELL, ERIC ROSS (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ROSS
Last Name:POWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 GRANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8512
Mailing Address - Country:US
Mailing Address - Phone:928-201-2334
Mailing Address - Fax:
Practice Address - Street 1:4000 HOLLYWOOD BLVD APT 600N
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6863
Practice Address - Country:US
Practice Address - Phone:928-201-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist