Provider Demographics
NPI:1326191446
Name:GROTENHUIS, BERNARDUS H (PT, FAAOMPT)
Entity type:Individual
Prefix:MR
First Name:BERNARDUS
Middle Name:H
Last Name:GROTENHUIS
Suffix:
Gender:M
Credentials:PT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 IONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2961
Mailing Address - Country:US
Mailing Address - Phone:847-289-1278
Mailing Address - Fax:630-369-5015
Practice Address - Street 1:630 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3237
Practice Address - Country:US
Practice Address - Phone:630-369-1015
Practice Address - Fax:630-369-5015
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist