Provider Demographics
NPI:1730129057
Name:GROTE, SUSAN WHITFIELD (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WHITFIELD
Last Name:GROTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-4570
Mailing Address - Country:US
Mailing Address - Phone:425-374-8383
Mailing Address - Fax:425-322-4421
Practice Address - Street 1:9518 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2234
Practice Address - Country:US
Practice Address - Phone:206-524-1058
Practice Address - Fax:206-524-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8924019OtherMEDICARE PTAN