Provider Demographics
NPI:1548627342
Name:GROVER, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GROVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 S 450 W
Mailing Address - Street 2:
Mailing Address - City:PONETO
Mailing Address - State:IN
Mailing Address - Zip Code:46781-9749
Mailing Address - Country:US
Mailing Address - Phone:260-694-6515
Mailing Address - Fax:
Practice Address - Street 1:5395 S 450 W
Practice Address - Street 2:
Practice Address - City:PONETO
Practice Address - State:IN
Practice Address - Zip Code:46781-9749
Practice Address - Country:US
Practice Address - Phone:260-694-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003908A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant