Provider Demographics
NPI:1235402058
Name:GROVE, AMANDA LAREE (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LAREE
Last Name:GROVE
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 55TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8268
Mailing Address - Country:US
Mailing Address - Phone:406-459-8840
Mailing Address - Fax:
Practice Address - Street 1:2621 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5201
Practice Address - Country:US
Practice Address - Phone:406-731-8930
Practice Address - Fax:406-731-8935
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist