Provider Demographics
NPI:1285179242
Name:GROH, JENNAFER MARIE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:JENNAFER
Middle Name:MARIE
Last Name:GROH
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7612
Mailing Address - Country:US
Mailing Address - Phone:989-891-9800
Mailing Address - Fax:989-891-0800
Practice Address - Street 1:2535 22ND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7612
Practice Address - Country:US
Practice Address - Phone:989-891-9800
Practice Address - Fax:989-891-0800
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005003225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant