Provider Demographics
NPI:1821317967
Name:GROVES, BRIAN TREVOR (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:TREVOR
Last Name:GROVES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:TREVOR
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:785 SE MCTAGGART RD
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9607
Mailing Address - Country:US
Mailing Address - Phone:541-475-2571
Mailing Address - Fax:
Practice Address - Street 1:910 SW HIGHWAY 97
Practice Address - Street 2:SUITE 200
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-475-2571
Practice Address - Fax:541-475-2590
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27912251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology