Provider Demographics
NPI:1083809123
Name:GROFF, JENNIFER LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:GROFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1202
Mailing Address - Country:US
Mailing Address - Phone:518-773-2300
Mailing Address - Fax:518-773-2334
Practice Address - Street 1:41 ARTERIAL PLZ
Practice Address - Street 2:SUITE 15B
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2512
Practice Address - Country:US
Practice Address - Phone:518-773-2300
Practice Address - Fax:518-773-2334
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB6400Medicare PIN