Provider Demographics
NPI:1316190580
Name:GROVER, DOROTHY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:GROVER
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 1:39 LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9445
Mailing Address - Country:US
Mailing Address - Phone:518-743-1819
Mailing Address - Fax:
Practice Address - Street 1:39 LAMBERT DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-9445
Practice Address - Country:US
Practice Address - Phone:518-743-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12080-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist