Provider Demographics
NPI:1972729176
Name:HOLLY MARIE GROSS
Entity Type:Organization
Organization Name:HOLLY MARIE GROSS
Other - Org Name:GIANTS COUNTRY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:218-229-2300
Mailing Address - Street 1:15 E 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705-1386
Mailing Address - Country:US
Mailing Address - Phone:218-229-2300
Mailing Address - Fax:218-229-2005
Practice Address - Street 1:15 E 1ST AVE N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705-1386
Practice Address - Country:US
Practice Address - Phone:218-229-2300
Practice Address - Fax:218-229-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-31
Deactivation Date:2008-02-01
Deactivation Code:
Reactivation Date:2008-07-31
Provider Licenses
StateLicense IDTaxonomies
MN5727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN591R5GROtherBCBSMN
DD5185OtherRAILROAD MEDICARE
MN235786100Medicaid
MNC04000Medicare PIN