Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1499 | WV |
NPI | 1003434192 |
---|---|
Provider Name | Jennifer Lee Grove |
First Address | Keyser, WV 26726-9262 |
Second Address | Keyser, WV 26726-9262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 06/07/2020 |