Provider Demographics
NPI:1861949620
Name:GROH, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GROH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17700 W CAPITOL DR STOP 6
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2080
Mailing Address - Country:US
Mailing Address - Phone:262-781-3083
Mailing Address - Fax:
Practice Address - Street 1:17700 W CAPITOL DR STOP 6
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-781-3083
Practice Address - Fax:262-781-3080
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13396-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist