Provider Demographics
NPI:1073775805
Name:GROENWALD, TAMMY M (DPT)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:GROENWALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:6112 E BROWN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:82505
Mailing Address - Country:US
Mailing Address - Phone:480-827-9707
Mailing Address - Fax:480-962-7154
Practice Address - Street 1:5656 S POWER RD
Practice Address - Street 2:STE 116
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8487
Practice Address - Country:US
Practice Address - Phone:480-840-3636
Practice Address - Fax:480-840-3640
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ80512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic