Provider Demographics
NPI:1306173265
Name:GROZMAN-AQUINO, CATHERINE M (PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:GROZMAN-AQUINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:V
Other - Last Name:GROZMAN-AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:7878 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3914
Practice Address - Country:US
Practice Address - Phone:414-354-6434
Practice Address - Fax:414-586-5745
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40256600Medicaid
WI462364661Medicare PIN