Provider Demographics
NPI:1518133735
Name:GROMER, TERRY R (PTA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:R
Last Name:GROMER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BOYCE DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3835
Mailing Address - Country:US
Mailing Address - Phone:715-365-6654
Mailing Address - Fax:715-365-6627
Practice Address - Street 1:900 BOYCE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3835
Practice Address - Country:US
Practice Address - Phone:715-365-6654
Practice Address - Fax:715-365-6627
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138-0192251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics