Provider Demographics
NPI:1619513744
Name:GROVES, HALEY ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ANNE
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 1:907 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1403
Mailing Address - Country:US
Mailing Address - Phone:810-875-5602
Mailing Address - Fax:
Practice Address - Street 1:6 LONGMEADOW VILLAGE DR STE 3
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7810
Practice Address - Country:US
Practice Address - Phone:269-687-0945
Practice Address - Fax:269-687-0960
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist