Healthcare Provider Details

I. General information

NPI: 1447604731
Provider Name (Legal Business Name): THE THERAPY GROVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 E LATHAM CT
GILBERT AZ
85297-3017
US

IV. Provider business mailing address

3712 E LATHAM CT
GILBERT AZ
85297-3017
US

V. Phone/Fax

Practice location:
  • Phone: 602-743-8815
  • Fax: 480-718-8788
Mailing address:
  • Phone: 602-743-8815
  • Fax: 480-718-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ROBINSON
Title or Position: CO-OWNER
Credential:
Phone: 602-743-8815