Healthcare Provider Details

I. General information

NPI: 1053393538
Provider Name (Legal Business Name): GROVE, ANDERSEN, GHIRINGHELLI PHYSICAL THERAPY A PROFESSIONAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HOSPITAL DR STE 101
VALLEJO CA
94589-2500
US

IV. Provider business mailing address

860 SOUTHAMPTON RD
BENICIA CA
94510-1907
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-8795
  • Fax: 707-552-9638
Mailing address:
  • Phone: 707-745-6144
  • Fax: 707-745-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. KATE ZITTERE
Title or Position: CONTROLLER
Credential:
Phone: 760-602-4106