Provider Demographics
NPI:1316302862
Name:GRUBER, HOLLY COPSEY (MPT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:COPSEY
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6173
Mailing Address - Country:US
Mailing Address - Phone:714-662-7425
Mailing Address - Fax:
Practice Address - Street 1:253 HANOVER DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6173
Practice Address - Country:US
Practice Address - Phone:714-662-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist