=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023260817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. PATRICIA R. GROSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 10/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1848 GREENTREE RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15220-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-344-7744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1655 CITATION DR
-----------------------------------------------------
City | SOUTH PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15129-8832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-956-6949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | TE006645
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------