MEDICARE: JOHN V GROVES MPT

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	225100000X	Physical Therapist	7378	MN

General Provider Information

NPI Number	:	1649206046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN V GROVES MPT

Provider Business Mailing Address
First Line	:	6300 SHINGLE CREEK PKWY
Second Line	:	SUITE 110
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2124
Country	:	US
Telephone Number	:	763-566-3798
Fax Number	:	763-566-3797

Provider Business Practice Location Address
First Line	:	6300 SHINGLE CREEK PKWY
Second Line	:	SUITE 110
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2124
Country	:	US
Telephone Number	:	763-566-3798
Fax Number	:	763-566-3797

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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