Provider Demographics
NPI:1215960281
Name:GROH, MICHAEL TODD (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:GROH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W PENN PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4308
Mailing Address - Country:US
Mailing Address - Phone:215-740-5563
Mailing Address - Fax:
Practice Address - Street 1:101 N MONROE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3037
Practice Address - Country:US
Practice Address - Phone:484-444-0135
Practice Address - Fax:484-444-0138
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR1586194OtherHIGHMARK BS
096716UUXMedicare ID - Type Unspecified