Mirian W Groenendaal, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1813 Issued in OR

Practice address

1957 Thompson Rd.
Coos Bay, OR 97420-2031

Phone

(541) 266-7050

Fax

(541) 266-0180

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mrs. Mirian W Groenendaal-Zomershoe Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337299200000",
    "number": "1124164678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202031",
            "telephone_number": "541-266-7050",
            "fax_number": "541-266-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 THOMPSON RD.",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202031",
            "telephone_number": "541-266-7050",
            "fax_number": "541-266-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROENENDAAL",
        "first_name": "MIRIAN",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2012-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "1813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182751",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS",
            "identifier": "410254301",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRIAN",
            "last_name": "GROENENDAAL-ZOMERSHOE",
            "middle_name": "W",
            "prefix": "MRS.",
            "credential": "P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ciera Lorraine Gray, FNP
• Greator Missouri Imaging Associates LLC
• Barbara Green
• Margaret Anne Greendale, RPH
• Howard Philip Grill, MD
• Andrea Gross
• Stephan J Groth, M.D.
• Julieann Elana Grubbs
• Catherine Gruchacz, M.D.
• Caithlyne Marie Guevarra

• Physical Therapist in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.