Basic Information
| Provider Information | |||||||||
| NPI: | 1053393538 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROVE, ANDERSEN, GHIRINGHELLI PHYSICAL THERAPY A PROFESSIONAL CO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GROVE, ANDERSEN, GHIRINGHELLI PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 SOUTHAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | BENICIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945101907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077456144 | ||||||||
| FaxNumber: | 7077455698 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 HOSPITAL DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | VALLEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945892500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075528795 | ||||||||
| FaxNumber: | 7075529638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | ZITTERE | ||||||||
| AuthorizedOfficialFirstName: | KATE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 7606024106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.