Provider Demographics
NPI:1477970911
Name:GROSHAN, DOREEN M (PTA, BS, AS)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:GROSHAN
Suffix:
Gender:F
Credentials:PTA, BS, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 NANTUCKET DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1762
Mailing Address - Country:US
Mailing Address - Phone:608-756-2972
Mailing Address - Fax:
Practice Address - Street 1:2620 WAUNONA WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1525
Practice Address - Country:US
Practice Address - Phone:608-212-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1925-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant