Provider Demographics
NPI:1700120250
Name:GROVES, AMY KATHERINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHERINE
Last Name:GROVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHERINE
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1230 POPE TRAMMEL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-8746
Mailing Address - Country:US
Mailing Address - Phone:270-943-0640
Mailing Address - Fax:
Practice Address - Street 1:1230 POPE TRAMMEL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-8746
Practice Address - Country:US
Practice Address - Phone:270-943-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant