Provider Demographics
NPI:1184723041
Name:GROOME, ANDREW ROBERT (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ROBERT
Last Name:GROOME
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6723 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8106
Mailing Address - Country:US
Mailing Address - Phone:225-926-2400
Mailing Address - Fax:225-926-2470
Practice Address - Street 1:6723 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8106
Practice Address - Country:US
Practice Address - Phone:225-926-2400
Practice Address - Fax:225-926-2470
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
02926F225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B890Medicare PIN