MEDICARE: GROVE, ANDERSEN, GHIRINGHELLI PHYSICAL THERAPY A PROFESSIONAL CO

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	225XH1200X	Hand Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1558343038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVE, ANDERSEN, GHIRINGHELLI PHYSICAL THERAPY A PROFESSIONAL CO

Provider Business Mailing Address
First Line	:	860 SOUTHAMPTON RD
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-1907
Country	:	US
Telephone Number	:	707-745-6144
Fax Number	:	707-745-5698

Provider Business Practice Location Address
First Line	:	860 SOUTHAMPTON RD
Second Line	:
City	:	BENICIA
State	:	CA
Zip	:	94510-1907
Country	:	US
Telephone Number	:	707-745-6144
Fax Number	:	707-745-5698

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. KATE ZITTERE
Credential	:
Telephone Number	:	760-602-4106

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/16/2018

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