Provider Demographics
NPI:1184889586
Name:GROVES, WESLEY DREXLER (DPT)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:DREXLER
Last Name:GROVES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 HAMILTON MASON RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1464
Mailing Address - Country:US
Mailing Address - Phone:513-759-6494
Mailing Address - Fax:
Practice Address - Street 1:7109 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1464
Practice Address - Country:US
Practice Address - Phone:513-759-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016476261QP2000X
OHPT012761261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00649321Medicare PIN
ILR02938Medicare PIN