Provider Demographics
NPI:1326775065
Name:GROSS, KAREN R (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 ALMONESSON RD SPC 26
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5259
Mailing Address - Country:US
Mailing Address - Phone:856-514-1153
Mailing Address - Fax:
Practice Address - Street 1:1500 ALMONESSON RD SPC 26
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5259
Practice Address - Country:US
Practice Address - Phone:856-514-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 2255A2300X, 226300000X
NJ18KT00758800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist