Individual
SHELLY GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4621 US HIGHWAY 59, GROVE, OK 74344-4237
(918) 314-1082
Mailing address
4621 US HIGHWAY 59, GROVE, OK 74344-4237
(918) 787-3797
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2055
OK
Other
Enumeration date
07/15/2015
Last updated
07/15/2015
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