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NPI Code Detail

MEDICARE: LINDA S GROVER PTA

MEDICARE: LINDA S GROVER PTA
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
1225200000XPhysical Therapy Assistant1400939KS

General Provider Information

NPI Number : 1972773505
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA S GROVER PTA
Provider Business Mailing Address
First Line : 1302 W 6TH ST
Second Line :
City : COFFEYVILLE
State : KS
Zip : 67337-3426
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2921 W 1ST ST
Second Line :
City : COFFEYVILLE
State : KS
Zip : 67337-2441
Country : US
Telephone Number : 620-251-6214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2008
Last Update Date : 03/11/2008

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Directions to “ LINDA S GROVER PTA” Practice Location

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