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NPI Code Detail

MEDICARE: MR. RYAN S GROVE ATC

MEDICARE: MR. RYAN S GROVE ATC
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
1174400000XSpecialistRT001346APA
2174400000XSpecialistAL 3939FL

General Provider Information

NPI Number : 1659365781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN S GROVE ATC
Provider Business Mailing Address
First Line : 3483 CRYSTAL LN
Second Line :
City : DAVIE
State : FL
Zip : 33330-4630
Country : US
Telephone Number : 412-292-6249
Fax Number :
Provider Business Practice Location Address
First Line : 7500 SW 30TH ST
Second Line :
City : DAVIE
State : FL
Zip : 33314-1020
Country : US
Telephone Number : 954-452-7008
Fax Number : 954-452-7069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2005
Last Update Date : 01/12/2015

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