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General NPI Number Information
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NPI Number | 1023634128
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Entity Type | Organization
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Legal Business Name | GROWING ROOTS PEDIATRIC THERAPY
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1216 PARKSIDE DR
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1267
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Country | US
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Telephone | 412-789-5759
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Fax |
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Provider Business Mailing Address
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Address Line | 4017 WASHINGTON RD # 122
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City | MC MURRAY
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State | PA
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Zip | 15317-2510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. GRACE HYLAND
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Credential | PT, DPT
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Telephone | 412-805-0561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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