Provider Demographics
NPI:1508972712
Name:NORTH GROVE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NORTH GROVE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRONEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-585-8474
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE 1600B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4201
Mailing Address - Country:US
Mailing Address - Phone:864-582-0019
Mailing Address - Fax:864-582-2160
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 1600B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-582-0019
Practice Address - Fax:864-582-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8636OtherSC MEDICARE PROVIDER #
SCDF4478OtherSC RAILROAD PROVIDER #
SC8636Medicare PIN