Provider Demographics
NPI:1619148111
Name:GROHOSKE, ALICE KAY (PTA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:KAY
Last Name:GROHOSKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4835
Mailing Address - Country:US
Mailing Address - Phone:850-932-6382
Mailing Address - Fax:850-932-9215
Practice Address - Street 1:450 RACETRACK RD NW
Practice Address - Street 2:SUITE G
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3837
Practice Address - Country:US
Practice Address - Phone:850-863-4698
Practice Address - Fax:850-863-8580
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20742225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant