Provider Demographics
NPI:1245328814
Name:GROH, KENNETH JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:GROH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 N SHERIDAN RD
Mailing Address - Street 2:VSC THERAPY
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2161
Mailing Address - Country:US
Mailing Address - Phone:847-356-4750
Mailing Address - Fax:847-356-4797
Practice Address - Street 1:1050 RED OAK LN
Practice Address - Street 2:THERAPY
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-4998
Practice Address - Country:US
Practice Address - Phone:847-356-4750
Practice Address - Fax:847-356-4797
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist