Provider Demographics
NPI:1720528516
Name:GROM, LINDSEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:GROM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9081 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-2509
Mailing Address - Country:US
Mailing Address - Phone:908-752-3187
Mailing Address - Fax:
Practice Address - Street 1:9081 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-2509
Practice Address - Country:US
Practice Address - Phone:908-752-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist