Provider Demographics
NPI:1679987325
Name:GROOVER-SMITH, ANITA LYNNE (LAT/ATC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LYNNE
Last Name:GROOVER-SMITH
Suffix:
Gender:F
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 WILLIAM PENN HIGHWAY
Mailing Address - Street 2:JUNIATA HIGH SCHOOL
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059
Mailing Address - Country:US
Mailing Address - Phone:717-436-2193
Mailing Address - Fax:717-436-2858
Practice Address - Street 1:3931 WILLIAM PENN HIGHWAY
Practice Address - Street 2:JUNIATA HIGH SCHOOL
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059
Practice Address - Country:US
Practice Address - Phone:717-436-2193
Practice Address - Fax:717-436-2858
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001192A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer