Provider Demographics
NPI:1861522971
Name:GROVES, SANDRA L (PT ASST)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GROVES
Suffix:
Gender:F
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:17 UNION ST
Mailing Address - City:MORRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13408-0601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2732
Practice Address - Country:US
Practice Address - Phone:315-363-8970
Practice Address - Fax:315-363-3130
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002928-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant