Provider Demographics
NPI:1528280450
Name:GROGG, LAURA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:GROGG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:835 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-2329
Mailing Address - Country:US
Mailing Address - Phone:419-692-3713
Mailing Address - Fax:
Practice Address - Street 1:4392 STATE ROUTE 235
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-9503
Practice Address - Country:US
Practice Address - Phone:419-634-8655
Practice Address - Fax:419-238-3612
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 008586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist