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General NPI Number Information
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NPI Number | 1508870189
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Entity Type | Individual
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Provider Name | COLIN R GROVE PT, DPT, MS, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 6630 UNIVERSITY AVE REHABILITATION CLINIC - MIDDLETON MAIL CODE 9430
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City | MIDDLETON
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State | WI
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Zip | 53562-3036
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Country | US
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Telephone | 608-263-8412
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1004
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Country | US
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Telephone | 404-712-8685
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Fax |
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | PT017062
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 4776-24
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License Number State | WI
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