Provider Demographics
NPI:1528509221
Name:ROSS, DAPHNE (PT, PRPC, WCS)
Entity type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT, PRPC, WCS
Other - Prefix:MRS
Other - First Name:DAPHNA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, PRPC, WCS
Mailing Address - Street 1:933 GROSVENOR PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2510
Mailing Address - Country:US
Mailing Address - Phone:510-255-3865
Mailing Address - Fax:
Practice Address - Street 1:250 LAFAYETTE CIR STE 107
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4389
Practice Address - Country:US
Practice Address - Phone:510-255-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist