Provider Demographics
NPI:1700826526
Name:GRUVER, LARRY ALLEN (MPT,ATC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
Last Name:GRUVER
Suffix:
Gender:M
Credentials:MPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4259
Mailing Address - Country:US
Mailing Address - Phone:480-840-6125
Mailing Address - Fax:480-840-6122
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:SUITE 126
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4259
Practice Address - Country:US
Practice Address - Phone:480-840-6125
Practice Address - Fax:480-840-6122
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q24353Medicare UPIN