Provider Demographics
NPI:1982928370
Name:GROVER, MATHEW (MPT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:GROVER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SUNCAST LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9664
Mailing Address - Country:US
Mailing Address - Phone:916-934-0914
Mailing Address - Fax:916-934-0960
Practice Address - Street 1:1200 SUNCAST LN
Practice Address - Street 2:SUITE 5
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9664
Practice Address - Country:US
Practice Address - Phone:916-934-0914
Practice Address - Fax:916-934-0960
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist