Healthcare Provider Details

I. General information

NPI: 1023235389
Provider Name (Legal Business Name): JANICE GROTH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MOUNTAINVIEW DR
HIGHLAND MILLS NY
10930-2643
US

IV. Provider business mailing address

51 S ROUTE 9W # 55
WEST HAVERSTRAW NY
10993-1055
US

V. Phone/Fax

Practice location:
  • Phone: 845-928-8364
  • Fax:
Mailing address:
  • Phone: 845-786-4676
  • Fax: 845-786-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003006-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: