Provider Demographics
NPI:1205109246
Name:GROENDYKE, AMBER JOY
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JOY
Last Name:GROENDYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1235
Mailing Address - Country:US
Mailing Address - Phone:712-324-6151
Mailing Address - Fax:712-324-6170
Practice Address - Street 1:118 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1235
Practice Address - Country:US
Practice Address - Phone:712-324-6151
Practice Address - Fax:712-324-6170
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001400225200000X
IA004892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer