Provider Demographics
NPI:1114531969
Name:GROENVELD, BRIANNA (PT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:GROENVELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:BIANCONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:2373 64TH ST SW STE 2100
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-7976
Practice Address - Country:US
Practice Address - Phone:616-235-3970
Practice Address - Fax:616-301-0480
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist