Provider Demographics
NPI:1821305954
Name:GRUBER, NANCIE ANNE (PT)
Entity Type:Individual
Prefix:
First Name:NANCIE
Middle Name:ANNE
Last Name:GRUBER
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 1:4866 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2142
Mailing Address - Country:US
Mailing Address - Phone:812-499-6544
Mailing Address - Fax:
Practice Address - Street 1:444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2846
Practice Address - Country:US
Practice Address - Phone:270-821-4444
Practice Address - Fax:270-821-9188
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-005656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400028402Medicare PIN