Provider Demographics
NPI:1003136938
Name:GROSSKOPF, DONALD RAY (LPTA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:GROSSKOPF
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:178 DRIFTWOOD POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3018
Mailing Address - Country:US
Mailing Address - Phone:850-417-6308
Mailing Address - Fax:850-278-6607
Practice Address - Street 1:2300 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1538
Practice Address - Country:US
Practice Address - Phone:850-678-5500
Practice Address - Fax:850-678-7400
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21489225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant