Provider Demographics
NPI:1982995817
Name:ROSS, JUAN C (MASSAJE THERAPIST)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ROSS
Suffix:
Gender:M
Credentials:MASSAJE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13549 SW 11TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1837
Mailing Address - Country:US
Mailing Address - Phone:305-303-2240
Mailing Address - Fax:
Practice Address - Street 1:13549 SW 11TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1837
Practice Address - Country:US
Practice Address - Phone:305-303-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9395208D00000X
FLMA62829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009966100Medicaid