Provider Demographics
NPI:1154347581
Name:CROSS, DANA (MSPT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417852
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7852
Mailing Address - Country:US
Mailing Address - Phone:443-409-0051
Mailing Address - Fax:443-409-0058
Practice Address - Street 1:101 WALTER WARD BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1210
Practice Address - Country:US
Practice Address - Phone:443-409-0051
Practice Address - Fax:443-409-0058
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ65836Medicare UPIN
MD221MN615Medicare ID - Type Unspecified