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NPI Code Detail

MEDICARE: EMILY ROSE GROBBEL DPT

MEDICARE: EMILY ROSE GROBBEL DPT
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 Therapist5501019665MI

General Provider Information

NPI Number : 1730793225
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ROSE GROBBEL DPT
Provider Business Mailing Address
First Line : 625 KENMOOR AVE SE
Second Line : STE 100
City : GRAND RAPIDS
State : MI
Zip : 49546-2395
Country : US
Telephone Number : 616-451-4284
Fax Number : 616-451-4811
Provider Business Practice Location Address
First Line : 3826 44TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3919
Country : US
Telephone Number : 616-451-4284
Fax Number : 616-451-4811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 10/20/2021

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Directions to “ EMILY ROSE GROBBEL DPT” Practice Location

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