Provider Demographics
NPI:1497939938
Name:GROW, MARC (MPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GROW
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARMA
Mailing Address - State:ID
Mailing Address - Zip Code:83660-0171
Mailing Address - Country:US
Mailing Address - Phone:208-722-7350
Mailing Address - Fax:208-722-7351
Practice Address - Street 1:2213 NORTH 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2458
Practice Address - Country:US
Practice Address - Phone:775-777-0901
Practice Address - Fax:775-777-0923
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2016-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV1463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100152Medicare PIN