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General NPI Number Information
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NPI Number | 1003136938
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Entity Type | Individual
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Provider Name | DONALD RAY GROSSKOPF LPTA
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Gender | Male
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 2300 PARTIN DR N
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City | NICEVILLE
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State | FL
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Zip | 32578-1538
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Country | US
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Telephone | 850-678-5500
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Fax | 850-678-7400
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Provider Business Mailing Address
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Address Line | 178 DRIFTWOOD POINT RD
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3018
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Country | US
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Telephone | 850-417-6308
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Fax | 850-278-6607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 21489
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License Number State | FL
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