MEDICARE: DR. JENNIFER STEPHANIE GROSSE P.T., D.P.T.,

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	225100000X	Physical Therapist	PT012460	GA

General Provider Information

NPI Number	:	1568917615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER STEPHANIE GROSSE P.T., D.P.T.,

Provider Business Mailing Address
First Line	:	105 HIGHLAND DR
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5720
Country	:	US
Telephone Number	:	912-800-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 TOWNE PARK DR STE 200
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5167
Country	:	US
Telephone Number	:	912-826-2533
Fax Number	:

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	01/03/2022

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