Provider Demographics
NPI:1730441627
Name:ROSS, JUDITH A (RPT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LUZERNE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2111
Mailing Address - Country:US
Mailing Address - Phone:203-230-1031
Mailing Address - Fax:
Practice Address - Street 1:18 TOWER LANE
Practice Address - Street 2:TOWER ONE TOWER EAST
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-776-0657
Practice Address - Fax:203-776-0667
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist