Provider Demographics
NPI:1023118213
Name:GROVE, ADENA M KELLY (PTA)
Entity type:Individual
Prefix:
First Name:ADENA
Middle Name:M KELLY
Last Name:GROVE
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:9225 UNIVERSITY BLVD
Mailing Address - Street 2:STE. D
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9149
Mailing Address - Country:US
Mailing Address - Phone:843-569-4546
Mailing Address - Fax:843-569-4535
Practice Address - Street 1:9225 UNIVERSITY BLVD
Practice Address - Street 2:STE. D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9149
Practice Address - Country:US
Practice Address - Phone:843-569-4546
Practice Address - Fax:843-569-4535
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant