Healthcare Provider Details

I. General information

NPI: 1447414735
Provider Name (Legal Business Name): CHRISTINA MARIE GRUVER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SAINT GEORGIA DR
HANOVER PA
17331-9424
US

IV. Provider business mailing address

30 SAINT GEORGIA DR
HANOVER PA
17331-9424
US

V. Phone/Fax

Practice location:
  • Phone: 717-630-3158
  • Fax: 717-630-3158
Mailing address:
  • Phone: 717-630-3158
  • Fax: 717-630-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE003051L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: