Provider Demographics
NPI:1457319733
Name:GROVE CITY PHYSICAL MEDICINE, L.L.C.
Entity Type:Organization
Organization Name:GROVE CITY PHYSICAL MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLANOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-820-2339
Mailing Address - Street 1:4070 GANTZ RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4816
Mailing Address - Country:US
Mailing Address - Phone:614-820-2339
Mailing Address - Fax:614-820-0339
Practice Address - Street 1:4070 GANTZ RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4816
Practice Address - Country:US
Practice Address - Phone:614-820-2339
Practice Address - Fax:614-820-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079466G208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2694384Medicaid
OH2694384Medicaid