Provider Demographics
NPI:1023391406
Name:GROVE PHYSICAL THERAPY L.L.C.
Entity Type:Organization
Organization Name:GROVE PHYSICAL THERAPY L.L.C.
Other - Org Name:GROVE PHYSICAL THERAPY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:305-722-0568
Mailing Address - Street 1:PO BOX 331932
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233
Mailing Address - Country:US
Mailing Address - Phone:305-722-0568
Mailing Address - Fax:305-670-0899
Practice Address - Street 1:3315 RICE STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-441-5258
Practice Address - Fax:305-441-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy