Provider Demographics
NPI:1336620640
Name:HARGROVE, JUNE GRAETER (LPTA)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:GRAETER
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 OLD MOODY RD
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524
Mailing Address - Country:US
Mailing Address - Phone:254-749-8269
Mailing Address - Fax:
Practice Address - Street 1:1890 OLD MOODY RD
Practice Address - Street 2:
Practice Address - City:EDDY
Practice Address - State:TX
Practice Address - Zip Code:76524
Practice Address - Country:US
Practice Address - Phone:254-749-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2008835225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant