Individual provider Active NPI

Harrison Tyler Grube

  • Physical Therapist
  • Dover, DE
National Provider Identifier
1255825485
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
642 S Queen St Ste 101
Dover, DE 19904-3506
Phone
(302) 724-6344
Fax
(302) 449-2047
NPI assigned
Jun 20, 2018
Last updated
Jun 20, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X DE Primary

Addresses

Primary practice location

642 S Queen St Ste 101
Dover, DE 19904-3506

Mailing address

1050 Industrial Rd Ste 210
Middletown, DE 19709-2801
Phone (302) 724-6344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1255825485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 INDUSTRIAL RD STE 210",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197092801",
            "telephone_number": "302-724-6344",
            "fax_number": "302-449-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 S QUEEN ST STE 101",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043506",
            "telephone_number": "302-724-6344",
            "fax_number": "302-449-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBE",
        "first_name": "HARRISON",
        "middle_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.