Provider Demographics
NPI:1598963985
Name:GROVES, NATASHA STANZILIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:STANZILIS
Last Name:GROVES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6050
Mailing Address - Country:US
Mailing Address - Phone:770-924-1285
Mailing Address - Fax:
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW
Practice Address - Street 2:BLDG. 300, SUITE 310
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1001
Practice Address - Country:US
Practice Address - Phone:770-974-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393730OtherBLUE CROSS BLUE SHIELD
GAG5BBFGKMedicare PIN