Provider Demographics
NPI:1336236892
Name:GROSKREUTZ, JONATHAN (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GROSKREUTZ
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 1:101 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1307
Mailing Address - Country:US
Mailing Address - Phone:712-707-5050
Mailing Address - Fax:
Practice Address - Street 1:101 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1307
Practice Address - Country:US
Practice Address - Phone:712-707-6060
Practice Address - Fax:712-707-6062
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN195K1GROtherBLUECROSS BLUESHIELD
MN350887100Medicaid
MNHP18577OtherHEALTH PARTNERS
MNHP18577OtherHEALTH PARTNERS
MN195K1GROtherBLUECROSS BLUESHIELD