Basic Information
| Provider Information | |||||||||
| NPI: | 1710293444 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GROSSMAN | ||||||||
| FirstName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2470 ROBERTSON BRIDGE RD | ||||||||
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| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975267232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412271756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1702 OWEN DR | ||||||||
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| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233184 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.