MEDICARE: MRS. RHEA M GROVER EFDA, PTDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	126800000X3	WA
2	101YP2500X	Professional Counselor	LPC19140	AZ

General Provider Information

NPI Number	:	1285745737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHEA M GROVER EFDA, PTDA

Provider Business Mailing Address
First Line	:	14629 W OBERLIN WAY
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-6747
Country	:	US
Telephone Number	:	623-760-5230
Fax Number	:

Provider Business Practice Location Address
First Line	:	14629 W OBERLIN WAY
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-6747
Country	:	US
Telephone Number	:	623-760-5230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/25/2025

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