Provider Demographics
NPI:1942273271
Name:GROTHMANN, MARK L (ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:GROTHMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6622
Mailing Address - Country:US
Mailing Address - Phone:610-429-2400
Mailing Address - Fax:
Practice Address - Street 1:450 ELLIS LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5123
Practice Address - Country:US
Practice Address - Phone:484-266-3938
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000133A225500000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer