Provider Demographics
NPI:1689044240
Name:GROSS, CAROLE LYNN
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:HIGH
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:40 MCCANN DR
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942-1767
Mailing Address - Country:US
Mailing Address - Phone:610-812-3376
Mailing Address - Fax:
Practice Address - Street 1:350 S MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4873
Practice Address - Country:US
Practice Address - Phone:215-348-3260
Practice Address - Fax:215-348-3282
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007924L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist