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General NPI Number Information
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NPI Number | 1245328814
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Entity Type | Individual
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Provider Name | KENNETH JOHN GROH P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 1050 RED OAK LN THERAPY
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City | LINDENHURST
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State | IL
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Zip | 60046-4998
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Country | US
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Telephone | 847-356-4750
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Fax | 847-356-4797
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Provider Business Mailing Address
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Address Line | 1324 N SHERIDAN RD VSC THERAPY
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City | WAUKEGAN
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State | IL
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Zip | 60085-2161
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Country | US
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Telephone | 847-356-4750
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Fax | 847-356-4797
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.009645
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License Number State | IL
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