Provider Demographics
NPI:1295281368
Name:GROSE, MEGAN ASHLEY (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ASHLEY
Last Name:GROSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 HELMSDALE PL APT 6202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2456
Mailing Address - Country:US
Mailing Address - Phone:419-681-4362
Mailing Address - Fax:
Practice Address - Street 1:1547 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2714
Practice Address - Country:US
Practice Address - Phone:859-744-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist