Provider Demographics
NPI:1972809143
Name:GROCHOWSKY, JESSICA PEARCE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PEARCE
Last Name:GROCHOWSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PEARCE
Other - Last Name:WHITELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 JULIAN LANE
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704
Mailing Address - Country:US
Mailing Address - Phone:828-684-3611
Mailing Address - Fax:828-684-3612
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 660
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:828-684-3611
Practice Address - Fax:828-684-3612
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25888225100000X
NCP15963225100000X
NC159632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY07NMOtherBC/BS
FLFH217XOtherPTAN
FLFH217XOtherPTAN