Provider Demographics
NPI:1104859891
Name:GROOMER, GEORGIA L (PT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:L
Last Name:GROOMER
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 1:11326 NEWKIRK
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4348
Mailing Address - Country:US
Mailing Address - Phone:210-413-8002
Mailing Address - Fax:
Practice Address - Street 1:11326 NEWKIRK
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4348
Practice Address - Country:US
Practice Address - Phone:210-413-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G6143Medicare ID - Type UnspecifiedSPECIALTY - 65