Provider Demographics
NPI:1285788158
Name:GROHNE, PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:GROHNE
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 1:969 MAIN ST
Mailing Address - Street 2:A STEP ABOVE PT
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7406
Mailing Address - Country:US
Mailing Address - Phone:781-899-8900
Mailing Address - Fax:
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7406
Practice Address - Country:US
Practice Address - Phone:781-899-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68580Medicare ID - Type UnspecifiedMY MEDICARE B NUMBER