Provider Demographics
NPI:1265417869
Name:GROOP, DAVID ALLEN (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:GROOP
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 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:215 N WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4813
Practice Address - Country:US
Practice Address - Phone:920-433-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10257-024OtherLICENSE
WI000222Medicare Oscar/Certification
WI000026Medicare Oscar/Certification
WI000030Medicare Oscar/Certification
WIQ22349Medicare UPIN
WI000033Medicare Oscar/Certification
WI000057Medicare Oscar/Certification
WI000104Medicare Oscar/Certification
WI000051Medicare Oscar/Certification
WI10257-024OtherLICENSE