MEDICARE: KATHRYN GRUPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	225100000X	Physical Therapist	005295	NY

General Provider Information

NPI Number	:	1508127374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GRUPP

Provider Business Mailing Address
First Line	:	60 PINE HILL RD
Second Line	:
City	:	HIGHLAND MILLS
State	:	NY
Zip	:	10930-3423
Country	:	US
Telephone Number	:	845-781-6557
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 PINE HILL RD
Second Line	:
City	:	HIGHLAND MILLS
State	:	NY
Zip	:	10930-3423
Country	:	US
Telephone Number	:	845-781-6557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	10/16/2012

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