Provider Demographics
NPI:1558544916
Name:GROLEAU, TAMMIE L (PT)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:L
Last Name:GROLEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ORCHARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-6605
Mailing Address - Country:US
Mailing Address - Phone:603-432-9821
Mailing Address - Fax:603-425-5194
Practice Address - Street 1:18 ORCHARD VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-6605
Practice Address - Country:US
Practice Address - Phone:603-432-9821
Practice Address - Fax:603-425-5194
Is Sole Proprietor?:No
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist