Healthcare Provider Details

I. General information

NPI: 1932758885
Provider Name (Legal Business Name): HANNAH NICOLE GROWE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19771 COAL HERITAGE RD
WELCH WV
24801-9825
US

IV. Provider business mailing address

163 VOTIVE PLACE GLADE SPRINGS RESORT
DANIELS WV
25832
US

V. Phone/Fax

Practice location:
  • Phone: 681-201-2009
  • Fax:
Mailing address:
  • Phone: 304-673-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004192
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: