Provider Demographics
NPI:1972560308
Name:GRUBER, CARA C (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:C
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:M
Other - Last Name:CHAMPION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-342-6737
Mailing Address - Fax:
Practice Address - Street 1:4480 MT HOPE RD
Practice Address - Street 2:STE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690
Practice Address - Country:US
Practice Address - Phone:231-938-2425
Practice Address - Fax:231-938-2453
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist