Healthcare Provider Details

I. General information

NPI: 1396654539
Provider Name (Legal Business Name): THE GROVE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SALK AVE
TAVARES FL
32778-4311
US

IV. Provider business mailing address

15051 GREEN VALLEY BLVD
CLERMONT FL
34711-8547
US

V. Phone/Fax

Practice location:
  • Phone: 561-629-3147
  • Fax:
Mailing address:
  • Phone: 561-629-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE PAPP
Title or Position: OWNER
Credential: OTR/L
Phone: 561-629-3147