Provider Demographics
NPI:1578152468
Name:GROEBNER, JODY (PTA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:GROEBNER
Suffix:
Gender:F
Credentials:PTA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4801 W 81ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1111
Mailing Address - Country:US
Mailing Address - Phone:612-239-2063
Mailing Address - Fax:
Practice Address - Street 1:10900 73RD AVE N STE 110
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5400
Practice Address - Country:US
Practice Address - Phone:763-315-1296
Practice Address - Fax:763-315-1297
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant