Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8051 | AZ |
NPI | 1073775805 |
---|---|
Provider Name | Ms. Tammy M Groenwald |
First Address | Mesa, AZ 82505 |
Second Address | Gilbert, AZ 85295-8487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |