Provider Demographics
NPI:1063277705
Name:GROVER, EMILIE ELIZABETHANN
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:ELIZABETHANN
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16607 E HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8718
Mailing Address - Country:US
Mailing Address - Phone:907-982-8639
Mailing Address - Fax:
Practice Address - Street 1:16607 E HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8718
Practice Address - Country:US
Practice Address - Phone:907-982-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist