Provider Demographics
NPI:1336149798
Name:GROVER, CHRISTIE JEAN (MPT, CERT MDT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:JEAN
Last Name:GROVER
Suffix:
Gender:F
Credentials:MPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4505
Mailing Address - Country:US
Mailing Address - Phone:609-267-1486
Mailing Address - Fax:
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:609-896-9054
Practice Address - Fax:609-896-9059
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00621700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ039068SY4Medicare ID - Type UnspecifiedPROVIDER NUMBER
NJ445887Medicare ID - Type UnspecifiedGROUP NUMBER