Provider Demographics
NPI:1649372160
Name:GRUBB, MARY BETH VERONICA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:VERONICA
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:3201 HIGHFIELD DR
Mailing Address - Street 2:SUITE G C/O CORE PHYSICAL THERAPY
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1113
Mailing Address - Country:US
Mailing Address - Phone:610-882-9611
Mailing Address - Fax:610-882-2717
Practice Address - Street 1:3201 HIGHFIELD DR
Practice Address - Street 2:SUITE G C/O CORE PHYSICAL THERAPY
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1113
Practice Address - Country:US
Practice Address - Phone:610-882-9611
Practice Address - Fax:610-882-2717
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT012648L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR1658088OtherHIGHMARK BLUE SHIELD
PA50047169OtherCAPITOL BLUE CROSS
PAGR1658088OtherHIGHMARK BLUE SHIELD