Individual
INGRID S GROSECLOSE
Active
Individual
INGRID S GROSECLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305208740
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073925541
MEDICAID QMB ONLY
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
06/02/2014
Last updated
08/09/2023
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