Provider Demographics
NPI:1972627099
Name:GROVE, PAMELA DARLENE (DPT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DARLENE
Last Name:GROVE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 MBA CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8298
Mailing Address - Country:US
Mailing Address - Phone:434-728-2866
Mailing Address - Fax:
Practice Address - Street 1:655 S WILLOW ST STE 128
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5723
Practice Address - Country:US
Practice Address - Phone:603-681-9294
Practice Address - Fax:888-979-6551
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC11417225100000X
VA2305002783225100000X
GACP015349T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist