Provider Demographics
NPI:1992875330
Name:MULLOY-GROH, CHRISTINA M (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:MULLOY-GROH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2897
Mailing Address - Country:US
Mailing Address - Phone:702-545-0555
Mailing Address - Fax:
Practice Address - Street 1:2629 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-545-0555
Practice Address - Fax:702-434-8985
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402668Medicaid
NVV36885Medicare PIN
NVV38331Medicare PIN