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NPI Code Detail

MEDICARE: MRS. WANDA EDWARDS GROVE PT

MEDICARE: MRS. WANDA EDWARDS GROVE PT
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
1225100000XPhysical Therapist2305006010VA

General Provider Information

NPI Number : 1427269430
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WANDA EDWARDS GROVE PT
Provider Business Mailing Address
First Line : 9860 FAIRFAX BLVD
Second Line : SUITE 1
City : FAIRFAX
State : VA
Zip : 22030-1737
Country : US
Telephone Number : 703-383-1616
Fax Number : 703-383-1166
Provider Business Practice Location Address
First Line : 9860 FAIRFAX BLVD
Second Line : SUITE 1
City : FAIRFAX
State : VA
Zip : 22030-1737
Country : US
Telephone Number : 703-383-1616
Fax Number : 703-383-1166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 10/10/2007

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