Healthcare Provider Details

I. General information

NPI: 1366882490
Provider Name (Legal Business Name): ROELFINA GROENWOLD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FROST LN
RAPHINE VA
24472-2423
US

IV. Provider business mailing address

40 FROST LN
RAPHINE VA
24472-2423
US

V. Phone/Fax

Practice location:
  • Phone: 540-533-6390
  • Fax:
Mailing address:
  • Phone: 540-533-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: