MEDICARE: LARRY ALLEN GRUVER MPT,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
1	225100000X	Physical Therapist	7159	AZ

General Provider Information

NPI Number	:	1700826526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY ALLEN GRUVER MPT,ATC

Provider Business Mailing Address
First Line	:	3336 E CHANDLER HEIGHTS RD
Second Line	:	SUITE 126
City	:	GILBERT
State	:	AZ
Zip	:	85298-4259
Country	:	US
Telephone Number	:	480-840-6125
Fax Number	:	480-840-6122

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD
Second Line	:	SUITE 126
City	:	GILBERT
State	:	AZ
Zip	:	85298-4259
Country	:	US
Telephone Number	:	480-840-6125
Fax Number	:	480-840-6122

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/24/2008

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