Provider Demographics
NPI:1700950078
Name:ROBERT C GROSSMAN & ASSOC PA
Entity Type:Organization
Organization Name:ROBERT C GROSSMAN & ASSOC PA
Other - Org Name:SPORTS & ORTHOPEDIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS
Authorized Official - Phone:301-989-9040
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-989-9040
Mailing Address - Fax:301-989-0939
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-989-9040
Practice Address - Fax:301-989-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD802235Medicare PIN