Provider Demographics
NPI:1033193438
Name:GROVES, PAMELA JEAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:GROVES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:VANLEEWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:THERAPEUTIC ASSOCIATES INC STE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:68643 HIGHWAY 20
Practice Address - Street 2:TAI CENTRAL OREGON SISTERS
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97759-1947
Practice Address - Country:US
Practice Address - Phone:541-549-3574
Practice Address - Fax:541-388-7785
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4855225100000X
CA18749225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027802Medicaid
OR386526Medicare ID - Type Unspecified