Provider Demographics
NPI:1750731352
Name:GROB, MICHELE (PT, DPT,COMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GROB
Suffix:
Gender:F
Credentials:PT, DPT,COMT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT,COMT
Mailing Address - Street 1:3360 GATEWAY RD.
Mailing Address - Street 2:UNIT 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-352-6940
Mailing Address - Fax:
Practice Address - Street 1:3360 GATEWAY RD GREENFIELD REHABILITATION AGENCY
Practice Address - Street 2:UNIT 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-923-7101
Practice Address - Fax:262-923-7178
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13422225100000X
WI13422-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist