Provider Demographics
NPI:1740812429
Name:GRUMBACH, AMANDA JO (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:GRUMBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18703 N HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:CURLEW
Mailing Address - State:WA
Mailing Address - Zip Code:99118-9652
Mailing Address - Country:US
Mailing Address - Phone:509-481-5605
Mailing Address - Fax:
Practice Address - Street 1:10 ROS CIR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5002
Practice Address - Country:US
Practice Address - Phone:509-775-8400
Practice Address - Fax:509-775-8401
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist