Provider Demographics
NPI:1669352852
Name:GROFF, REBECCA (PTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GROFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR STE 213
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7503
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:
Practice Address - Street 1:200 NEWPORT CENTER DR STE 213
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7503
Practice Address - Country:US
Practice Address - Phone:949-644-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant