Provider Demographics
NPI:1811164064
Name:GROVE, SHEILA MAHIGAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:MAHIGAN
Last Name:GROVE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1625 RADIO DR STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9476
Mailing Address - Country:US
Mailing Address - Phone:651-241-3636
Mailing Address - Fax:651-241-3646
Practice Address - Street 1:1625 RADIO DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9407
Practice Address - Country:US
Practice Address - Phone:651-241-3636
Practice Address - Fax:651-241-3646
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant