Robert Ross

 
 From dcatalyst16 
 18443858095 
 8/29/2022 10:58:59 PDT 
 Page 13 of 17 
 Dr Billy Bryant MD 
 Today's Date: 26 Mar 2016
 RehabOne Medical Group, Inc. 
 All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 94332 
 Industrial Injury Info: 
 date of birth: 
 23 Jun 1987 
 Adjuster: Jennifer Restori 
 Claim # 
 00546284807-WC-01 
 Phone # 916-437-4336 
 INJURY DATE: 
 04 May 2019 
 Fax # 
 866-430-0438 
 Insurance: Gallagher Bassett (Corona) 
 Patient Info: 
 Address: 
 100 Franco Falls Suite 363
Richardville, MA 57287
 Phone (C): 831-430-3439 
 Pref. Lang.: 
 English 
 Diagnosis: 
 M43.17 
 Intervertebral disc disorders with radiculopathy, lumbosacral region 
 Case Type: 
 Work Compensation 
 176 Robert Ross : Aug 25, 2022 
 page 12 
