Provider Demographics
NPI:1578652178
Name:GROVE, DONNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:GROVE
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 1:4467 W VAQUERO LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8060
Mailing Address - Country:US
Mailing Address - Phone:928-276-5422
Mailing Address - Fax:
Practice Address - Street 1:1951 W 25TH ST
Practice Address - Street 2:STE. C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6925
Practice Address - Country:US
Practice Address - Phone:928-726-7900
Practice Address - Fax:928-726-7901
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0293620OtherBLUE CROSS OF AZ
AZ28380Medicare ID - Type UnspecifiedMEDICARE