Provider Demographics
NPI:1891842654
Name:GROVE, DAWN R (PTA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:GROVE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 BIG RD
Mailing Address - Street 2:
Mailing Address - City:ZIEGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19492-9705
Mailing Address - Country:US
Mailing Address - Phone:610-682-1478
Mailing Address - Fax:
Practice Address - Street 1:1 S HOME AVE
Practice Address - Street 2:
Practice Address - City:TOPTON
Practice Address - State:PA
Practice Address - Zip Code:19562-1317
Practice Address - Country:US
Practice Address - Phone:610-682-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005405L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant