1326191446 NPI number — MR. BERNARDUS H GROTENHUIS PT, FAAOMPT

Table of content: MR. BERNARDUS H GROTENHUIS PT, FAAOMPT (NPI 1326191446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326191446 NPI number — MR. BERNARDUS H GROTENHUIS PT, FAAOMPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROTENHUIS
Provider First Name:
BERNARDUS
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, FAAOMPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326191446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 IONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60177-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-289-1278
Provider Business Mailing Address Fax Number:
630-369-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 E OGDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-369-1015
Provider Business Practice Location Address Fax Number:
630-369-5015
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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