MEDICARE: SUSAN WHITFIELD GROTE 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
1	225100000X	Physical Therapist	PT00007200	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8924019	OTHER	WA	MEDICARE PTAN

General Provider Information

NPI Number	:	1730129057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WHITFIELD GROTE PT

Provider Business Mailing Address
First Line	:	PO BOX 1570
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-4570
Country	:	US
Telephone Number	:	425-374-8383
Fax Number	:	425-322-4421

Provider Business Practice Location Address
First Line	:	9518 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2234
Country	:	US
Telephone Number	:	206-524-1058
Fax Number	:	206-524-1059

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/11/2017

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