Provider Demographics
NPI:1649395278
Name:GROVES, KIMBERLY ROBIN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROBIN
Last Name:GROVES
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ORCHARD HEIGHTS
Mailing Address - Street 2:P.O. BOX 493
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-0493
Mailing Address - Country:US
Mailing Address - Phone:304-846-2916
Mailing Address - Fax:
Practice Address - Street 1:RT. 92 BOX 249
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-0249
Practice Address - Country:US
Practice Address - Phone:304-536-4661
Practice Address - Fax:304-536-1328
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV416225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant