Healthcare Provider Details

I. General information

NPI: 1144301672
Provider Name (Legal Business Name): ROBERT J. GROW MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 NORTH MOAPA VALLEY BLVD. SUITE B
OVERTON NV
89040
US

IV. Provider business mailing address

PO BOX 757
MESQUITE NV
89024-0757
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-1899
  • Fax: 702-346-8581
Mailing address:
  • Phone: 702-346-1899
  • Fax: 702-346-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1563
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: