Healthcare Provider Details

I. General information

NPI: 1023391406
Provider Name (Legal Business Name): GROVE PHYSICAL THERAPY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 RICE STREET
MIAMI FL
33133
US

IV. Provider business mailing address

PO BOX 331932
MIAMI FL
33233
US

V. Phone/Fax

Practice location:
  • Phone: 305-441-5258
  • Fax: 305-441-5259
Mailing address:
  • Phone: 305-722-0568
  • Fax: 305-670-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD YACOUB
Title or Position: PRESIDENT
Credential: MSPT
Phone: 305-722-0568