Provider Demographics
NPI:1427122795
Name:GROSSMAN, ROBERT C (PT OCS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-989-9040
Mailing Address - Fax:301-989-0939
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-989-9040
Practice Address - Fax:301-989-0939
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184778S35Medicare PIN