Provider Demographics
NPI:1467860825
Name:GROVER, KATHERINE ALEXANDRA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ALEXANDRA
Last Name:GROVER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SAINT STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1727
Mailing Address - Country:US
Mailing Address - Phone:703-973-7927
Mailing Address - Fax:
Practice Address - Street 1:1000 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1727
Practice Address - Country:US
Practice Address - Phone:703-212-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer